Block - Child and Adolescent Health - Handbook

Specialty Block Handbook
Term E 2016
Version 53
2016 Sydney Medical School, University of Sydney

Jayne Seward <jayne.seward@sydney.edu.au>
Table of Contents
Child and Adolescent Health Specialty Block............................................ 3

General Aims .............................................................................................................................................................. 3
Curriculum Themes..................................................................................................................................................... 3
Sydney Medical School Stage 3 Attendance Policy .................................................................................................... 3
CAH Contacts ............................................................................................................................................................. 3
Aims and Objectives of the Child & Adolescent Health Specialty Block ...................................................................... 4
Block Structure............................................................................................................................................................ 5
Structured Teaching Program ..................................................................................................................................... 5
Clinical Attachments ................................................................................................................................................... 8
Assessment ................................................................................................................................................................ 9
Resources Section ................................................................................. 11

Resource 1: Patient Doctor Competencies ............................................................................................................... 11
Resource 2: A Guide to CAH Basic and Clinical Sciences ....................................................................................... 16
Resource 3: PBL Cases from Years 1 and 2 Assumed Knowledge for CAH Specialty Block ................................ 20
Resource 4: Recommended Texts............................................................................................................................ 21
Resource 5: Adolescent Medicine............................................................................................................................. 22
Resource 6: Medical Bedside Tutorials ..................................................................................................................... 24
Resource 7: Surgical Component of Child & Adolescent Health Specialty Block ..................................................... 32
Resource 8: Surgical Tutorials .................................................................................................................................. 33
Resource 9: Personal & Professional Development Theme Objectives .................................................................... 34
Resource 10: Guidelines for Structured Paediatric Written History ........................................................................... 35
Child and Adolescent Health 2016 Sydney Medical School

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Child and Adolescent Health Specialty Block
The combination of structured teaching, clinical experience and self-directed learning in the Child and Adolescent Health
curriculum will provide learning opportunities that will equip you for internship and beyond. Whichever area of medicine you
ultimately choose to work in will involve addressing the health needs of children and young people.
We trust that you will find the Block both enjoyable and a valuable learning experience. We recommend you read through the
handbook as it outlines the learning and teaching and the assessment requirements of the Block. The CAH website contains
resources to support your learning, including materials related to clinical reasoning sessions and lectures, as well as practice
activities, assessment resources, additional learning resources and administrative information.
General Aims
To provide you with the learning opportunities required to develop the level of competence in paediatric and
adolescent medicine of an intern / post-graduate year 1 resident medical officer
To introduce you to a balanced view of the health needs of infants, children and adolescents, and their
management in a range of health facilities, from primary to quaternary.
Curriculum Themes
Patient & Doctor: You will build on core clinical and communication skills required for working in paediatrics at commencement
of internship. A broad range of these skills is detailed in the Resources section under Patient and Doctor competencies and
Medical and surgical tutorials.
Basic & Clinical Science: You will build on your knowledge base gained with the first two stages of the program and will learn
to apply your knowledge across the complex and broad areas of child and adolescent health.
Community & Doctor: You will gain experience of health care across a range of hospital and community settings and develop
an appreciation of the importance of good multi-disciplinary communication in establishing and maintaining continuity of care.
You will also develop knowledge and understanding of a number of issues relating to preventive medicine and health promotion.
Personal & Professional Development: You will have the opportunity to consider ethical and medico-legal issues relating to
illness and health care for children and adolescents and will further explore your own personal beliefs, ideas and feelings to
become better equipped to work in these two challenging areas of medicine. You will demonstrate your professional behaviour
by meeting attendance requirements with active participation and employ ethical principles in your clinical approach.
Sydney Medical School Stage 3 Attendance Policy

Please refer to the Attendance and Leave in the SMP policy document for further detail:
http://sydney.edu.au/medicine/current-students/policies-forms/medical-program/index.php
CAH Contacts
Where Contact Phone Email
Dr Hasantha Gunasekera
The Childrens (CAH Co-ordinator; Sub-Dean Education)
9845 3446 hasantha.gunasekera@health.nsw.gov.au
Hospital at Dr Megan Phelps
Westmead 9845 3374 meg.phelps@health.nsw.gov.au
(Sub-Dean Student Support Tue & Thurs)
Dr Karen Scott
9845 3385 karen.scott@health.nsw.gov.au
(Snr Lecturer; CAH eLearning Coordinator)
Vikki Cheetham
9845 3376 vikki.cheetham@health.nsw.gov.au
(Manager, Teaching and Learning)
Joanne Michel SCHN-USydPaeds
9845 3446
(Student Admin Officer) ClinicalSchool@health.nsw.gov.au
Dr Helen Young
Northern 9926 7111 helen.young2@health.nsw.gov.au
(via RNSH Switch)
Clinical School Kay Worrell
9926 4687 kay.worrell@sydney.edu.au
(Education Support)
Prof Ralph Nanan ralph.nanan@sydney.edu.au
Nepean Clinical Dr Tony Liu athony.Liu@health.nsw.gov.au
School Dr Alison Poulton alison.poulton@sydney.edu.au
4734-3363
Karen Burnham
karen.burnham1@health.nsw.gov.au
(Secretary)
Dubbo Campus: 02 6841 2471 jacqueline.askwith@gwahs.health.nsw.gov.au
School of Rural
Dr Jacky Askwith
Health 02 5809 9418 julia.wild@sydney.edu.au
Julia Wild (Education Support)
Orange Campus: 02 6393 3060 paul.bloomfield@health.nsw.gov.au
Dr Paul Bloomfield
Annemarie Woltmann & Sharon Martin 02 5310 4103 srhorange.eso@sydney.edu.au
(Education Support)

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Aims and Objectives of the Child & Adolescent Health Specialty Block
Aim
To develop the level of competence in paediatrics and adolescent medicine expected of an intern, building on prior
learning in paediatrics
Learning Objectives: Assessment
Students will be expected to: (summative)
1
1. Apply the core clinical skills needed to assess a child and adolescent, with MCQ
particular awareness of age related changes: Clinical Task
- paediatric history taking in the context of the child and adolescent and their family Paper &
- paediatric examination OSCE
- basic management skills (such as charting intravenous fluids and medications) (i.e. Block exam)
1
2. Demonstrate the skills required to communicate effectively with the child and OSCE
adolescent and their carers:
- to gain the cooperation and trust of the child and adolescent
- to explain differential diagnoses, investigations and procedures, and management
- to the carers and child and adolescent as appropriate
3. Demonstrate knowledge of the diagnostic investigations and procedures relevant Block exam
1
to the child and adolescent
4. Apply an understanding of the physiological and psychological changes during Block exam
2
childhood and adolescence and how these affect clinical manifestations of
disease, and management of clinical conditions
5. Apply and interpret knowledge and understanding of child and adolescent Block exam
2
development including:
- the wide range of developmental progress
- the developmental history and examination
- the indications for follow up and referral
6. Apply knowledge of feeding, growth and nutrition including interpretation of growth Block exam
1,2
charts
7. Apply knowledge and understanding of the common and important medical and Block exam
2
surgical conditions in relation to different age groups:
- neonate, infant, toddler,
- preschool and school age child and adolescent; and the diagnosis and
- management of these conditions
3
8. Apply understanding of the health of the child and adolescent in the community Block exam
including:
- delivery of healthcare to Aboriginal and Torres Strait Islander children
- aspects of primary, secondary and tertiary prevention
- health promotion
- child advocacy and the influence of broader factors on the health of the child and
- adolescent e.g. cultural, environmental and political factors
- services for child and adolescent in urban and rural communities
- importance of multidisciplinary communication between services and the family
- critical appraisal of community interventions
9. Apply understanding of the Personal & Professional Development Theme Written clinical
3
objectives underlying all components of the course, with particular emphasis on: attachment
- ethical and medico-legal issues in relation to illness and health care of children and appraisals;
adolescents Block exam;
- personal and professional challenges of working in the paediatric context Attendance &
- responsible clinical practice and commitment to ongoing improvement participation
records
10. Demonstrate development in understanding of evidence based medicine Block exam
2,3
principles underlying all components of course, in particular:
- application of EBM to individual patient and their family
- critical appraisal of available evidence in paediatrics
- interpretation of synthesised evidence: systematic reviews, meta-analyses and
evidence based guidelines
References
1. CAH handbook, Resources section: Patient & Doctor Theme competencies
2. CAH handbook, Resources section: A guide to Basic and Clinical Sciences in CAH block
3. CAH handbook, Resources section: Personal & Professional Development Theme objectives

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Block Structure
The first day of the block and the whole of Week 5 are for dedicated structured teaching, including: lectures, workshops, practical
skills sessions and Clinical Application Sessions with Experts (CASES). From the second day of the block and the rest of that week,
and then Weeks 2 to 4, 6 & 7 you will be on clinical attachments. In addition to the School of Rural Health locations (Dubbo and
Orange), we have rural attachments available for clinical placements in Lismore (subject to availability).
During Weeks 1 to 7 you will also have Medical bedside tutorials, Surgical tutorials and Clinical Reasoning Sessions. Week 8 is set
aside for summative assessments. Further assessments for students who were not satisfactory are held on the Friday of Week 8.
The CAH Specialty Block at a Glance

Week Activities Assessment due
Day 1: CAH block orientation, introductory
lectures and Basic Life Support Skills
1 (some students: surgical tutorials) Friday p.m. clinical attachment appraisal form due*
From Day 2: Clinical attachments
Clinical attachments Friday p.m. clinical attachment appraisal form due*
3 Clinical attachments Friday p.m. clinical attachment appraisal form due*
Clinical Application Sessions with Experts
5
(CASE), lectures, workshops, Clinical Required Formative Assessment: Structured written history
(structured
Reasoning Sessions (CRS), medical due Monday 8.30am
teaching)
bedside and surgical tutorials
Required Assessment: Physical Exam Marking Sheet DUE
7 Clinical attachments into CHW Clinical School by 5pm Wednesday Week 7
Friday p.m. clinical attachment appraisal form due*
Monday: Clinical Task Papers and MCQ (Camperdown
campus & SRH)
8 Summative assessment
Wednesday: OSCE (CHW & SRH)
Friday further assessment as necessary (CHW only)
NB: Required learning activities = all of Day 1, all of week 5 and a minimum 28 hours per clinical attachment week and
additional to that all the regular tutorials (i.e., medical bedside, surgical and CRS).
* Clinical attachment appraisal forms are a PPD and Pt-Dr Theme requirement for every clinical attachment week.
Northern Clinical School students will spend either two or four weeks of the block based at Royal North Shore Hospital (+-
associated sites Mona Vale and Hornsby).
Westmead and Nepean Clinical School students will spend either two or four weeks of the block based at Nepean Hospital and
associated clinical teaching centres.
School of Rural Health (Dubbo and Orange sites) offers a fully integrated program of structured teaching, hospital and
community-based clinical placements in child and adolescent health for the full eight week period.
Structured Teaching Program
Clinical Reasoning Sessions (CRS)

The focus of the CRS is clinical application of knowledge through real patient doctor encounters. Each student should make a
contribution to each CRS (either presenting a case, presenting an EBM critical appraisal or a learning topic).
CRS 1 (2 hours): Your tutor will facilitate this session by presenting a classic paediatric case. The tutor will then go through the
AGREE instrument for the critical appraisal of guidelines. A student will be allocated to present the case for the next CRS and
two other students will be asked to present an EBM critical appraisal (guideline, review or RCT). Other students will be given
learning topics to present at the next CRS.
CRS 2-5 (2 hours): A student will present a case. We suggest an evolving story rather than presenting all the facts immediately
so that other students can use clinical reasoning to deduce the most likely cause and the best management. The students
allocated to EBM should present a brief appraisal of the evidence in relation to one of the learning topics.
CRS 6 (1 hour): This session is as per CRS 2 to 5 except that there is no case presentation.

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The cases presented in the CRS are as follows:
Week 1: Respiratory disease
Week 2: The febrile child
Week 3: Developmental delay
Week 4: Chronic disease in an adolescent
Week 5: Vomiting illnesses
Evidence Based Medicine in the Clinical Reasoning Process

In this block, EBM is fully integrated into the clinical reasoning process.. Some of the processes should be revision, however, we
will also cover the critical appraisal of guidelines using the AGREE instrument. Similarly, assessment of EBM is integrated within
the BCS and Pt-Dr summative assessment tasks
EBM is contextualised within the clinical reasoning process, which will facilitate your engagement with the real life applications of
EBM. When you are the student tutor, you must ensure that EBM is built in to the patient case and that the two members from
your group who have been assigned the EBM task for the case take responsibility for completing the task.
The EBM component of the first CRS case is explored in detail in the first CRS tutorial. The session looks at using synthesised
data in systematic reviews and clinical practice guidelines. Specifically, the session covers:
- where to look for information to support the possible diagnosis and management for CRS case 1
- the purpose of, and where to find, a systematic review, narrative review, meta-analysis and clinical practice -guidelines
- the JAMA checklist to critically appraise a systematic review
- the AGREE II instrument to critically appraise clinical practice guidelines.
What students need to do for the EBM Task

When you are allocated to an EBM presentation, we expect you to present a critical appraisal of the evidence,
rather than just reporting the evidence.
For this purpose we recommend finding a guideline, a systematic review, a meta-analysis or an RCT relevant to
the patient-based case
We expect you to use a structured critical appraisal tool (e.g., JAMA or AGREE) rather than just your subjective
opinion of the evidence. These are available on the website.
Use this evidence to assist your clinical decision making in the management of the patient case and/or develop
an information sheet suitable for the family/carer of the patient.
Roles & Responsibilities in Clinical Reasoning Sessions

Your responsibilities as a student tutor and group member, and the role of your clinical tutor, are detailed below. Primarily the
student tutor facilitates the tutorial and the clinical tutor acts as a guide on the side.
Roles Responsibilities
Student Tutor You should augment the case with your own reading and clinical experience and:
- find an appropriate patient to present
- (please do not go to the ED or ICU to find a patient and please do not find an oncology patient))
- construct a clinical reasoning guide, which you can use to facilitate the session
- discuss your clinical reasoning guide with your clinical tutor if required
- act as facilitator for the clinical reasoning group
- ensure all students report back on their learning tasks, including the EBM tasks.
Group Member As a group member you are expected to:
- attend every clinical reasoning tutorial
- participate in and contribute constructively to the discussion
- work co-operatively with other group members
- take individual responsibility for your learning topic / EBM tasks.
Clinical Tutor - be familiar with the web-based clinical reasoning guidelines, including EBM component
- be available for consultation - for example, to discuss how to present patient case, and/or guide
student in selection of patient case
- act as a mentor, coach and guide throughout the clinical reasoning process, including EBM
coverage
- attend tutorials & monitor the tutorial process
- strike a balance between being too dominant versus too laid back
- contribute when appropriate to the discussion
- provide constructive feedback
- confirm that all individual group members have reported back on their learning tasks, including
EBM tasks.

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Steps in the Clinical Reasoning Process
Step 1: Case Allocation

At the beginning of the block you will be allocated a week in which to present your CRS case. Four students will facilitate a case
during the block CRS tutes. Please note: all students should also be presenting cases during your clinical rotations as well.
Step 2: Review/Work through web-based clinical reasoning case

Review/work through the web-based guidelines to familiarise yourself with the case content and key issues that need to be
considered or raised in your clinical reasoning sessions. You will find the parameters for selecting a patient in the guidelines.
Step 3: Prepare your clinical reasoning tutorial

Contact your clinical tutor for advice in selecting a patient (if needed)
Select a patient
Remember to review the support material on the CAH website and contact your clinical tutor if needed.
Patient history & examination

Take your own history from the patient and perform a physical examination. Then, without referring to the patient
notes, determine a working diagnosis and initial management plan for the patient. Review the patient notes to
check your provisional diagnosis and analyse how the clinicians have managed the case. Think about your
clinical reasoning during the consultation - how does it compare with the clinicians management of the case?
Develop clinical reasoning guide

Use the clinical reasoning guide template for each case on the CAH website to develop your case presentation
and prepare your tutorial. You may find the following questions helpful when developing your reasoning guide:
o How did the patient present? What is the trigger/event to be presented to the group?
o How you will present the history, examination and investigations in response to group questions?
o What was the management plan and were there any underlying issues that needed to be managed?
o What other treatment options might there be and any qualifying factors
o What level of involvement did other clinicians/agencies have during management of case?
o What are the main/related issues associated with the case?
o What related learning is associated with the case (refer to the web-based case for the key learning topics)
and think about how the group will share the responsibility for the associated learning tasks.
Prepare for case facilitation

When preparing your tutorial you should think about how you will engage and challenge the group. The questions
provided in the template are a useful starting point. A variety of resources are available on the CAH web site to
help you prepare for tutorial facilitation.
Step 4: Run your clinical reasoning tutorial

When you run your tutorial, you are responsible for facilitating discussion and promoting the clinical reasoning process.
Your role as a student tutor is to:
stimulate the discussion
provide your group with information as necessary, as the case discussion progresses
encourage your group to draw on their current/past clinical experiences
evaluate progress being made
monitor the extent to which each group member contributes to the group's objectives
Generally speaking, by the end of the tutorial, your group should have made a diagnostic decision and started to
discuss patient management, in broad terms. The tutorial should adopt a strong management focus, including
discussion about:
o What has been learnt from the self-directed learning activities
o What clinical questions have arisen? How would you use evidence to answer those questions?
o Initial and on-going management issues (including whether there are appropriate written resources)
o Short and long term management goals and treatment plans
o Disease prevention and health promotion opportunities

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Other Structured Teaching
Procedural skills and other workshops

Small group structured teaching sessions are an important feature of this block and include:
Procedural skills sessions (multiple stations covering medical and surgical procedural teaching)
Asthma management, fluids, cardiac pathology, murmurs, immunisation, ethics and the Indigenous health forum.
See the Blackboard CAH site for self-directed learning resources associated with the asthma, fluids and pain management
workshops, and videos/guidelines associated with the procedural skills, C-spine/intraosseous, BLS, Immunisation and murmurs.
Clinical Application Sessions with Experts (CASE)

The CAH block involves a number of lectures, interactive sessions with experts and skills sessions, which provide overviews of
important areas in paediatrics. These will take place on day 1 and week 5. In week 5, we have CASEs (Clinical Application
Sessions with Experts), in which an expert (usually the lecturer from the online resource) will answer any questions you may have
and go through clinical scenarios that demonstrate clinical application of the content in the online CASE preparatory material. Some
sessions are presented by a multidisciplinary team of medical, allied health, nursing and science staff. These sessions are
interactive, they are not didactic lectures: so be prepared to ask or be asked questions and get the most out of this time.
The Blackboard CAH site has all the self-directed learning resources:
CASE preparatory material (short pre-lecture recordings and quizzes), which are expected prior learning for
CASE sessions. There are also related learning resources and recommended references and links.
audio recordings and Powerpoint slides of the small number of CAH lectures
learning activities in important areas of paediatrics for you to revise and extend your learning
learning resources for Clinical Reasoning Session (CRS), and videos/guidelines for Procedural skills
links to recommended Paediatrics websites and information on assessment.
The Compass CAH site has information on clinical placements and administration of the CAH block.
Small group teaching (see resource section)

Bedside tutorials (weeks 1 to 6) for small groups (~5 students) covering core history-taking and physical examination skills
Surgical tutorials (weeks 1 to 6) for core surgical learning
Clinical Attachments
During the clinical attachments weeks you will be assigned to a mix of medical and surgical placements. Look on the CAH
website for the weekly schedules for teams (under Clinical Attachments). These attachments have been organised to provide
you with exposure to a variety of clinical settings and teams.
Students must attend a minimum of 28 hours each week plus any scheduled medical/surgical tutorials and CRS.
You need to make arrangements with your supervisor to complete the clinical appraisal form (see CAH website under clinical
attachments) each week. Please show the form to your supervisor on the first day of your attachment. On every day of the clinical
attachment, you will need to write the names of the activities you have been involved in.
Supervisors are expected to involve you in the work of the team. You should practice history taking and physical examination,
observe procedures and practise documenting in the medical record (countersigned by medical staff). You should present cases
on ward rounds and team or departmental meetings. See the Patient Doctor Competencies in the Resources Section.
We expect all students to treat their clinical placements as they would their employment:
Notify your team (who you report to most often i.e., Fellow/Registrar) and the Clinical School if you are unable to
attend on the day NB: teams are asked to inform us of absences and PPD procedures apply
Notify your team if you are leaving to attend a tutorial, and advise when you will be returning
We expect students to undertake the following activities:

Perform and document a history and examinations on at least two patients every week
Ensure that growth charts are complete for each patient on the team (i.e., take measurements and enter them)
Look up and interpret with your Registrar/Resident: blood and X-ray results, patient observation charts (e.g., vital
signs, fluid balance, medication charts)
Maximise your time with the team and ensure you attend the placement and are involved
Clinical attachments offer a wonderful opportunity for learning: We hope you enjoy your contact with the children and their carers.
Critical Incidents: As with all placements, it is most important that you advise your clinical school coordinators and/or other senior
staff about any problems which you may encounter. This includes all matters regarding any concerns about patients and their
families, staff members or other students. Complete confidentiality is a responsibility of both students and supervisors.

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Assessment
Required formative assessments
Clinical Attachment Appraisal Forms: due on Friday afternoons
One form is required for each clinical attachment week (see COMPASS/CAH Clinical Attachments).
Structured Written History: due on Monday of Week 5

The Structured Written History is designed to provide guidance, practice and feedback on the aspects of history-taking that are
essential to paediatrics and is in preparation for the week 8 summative assessments. Guidelines for the task are listed under
Resource 10 of this handbook.
Basic and Clinical Science

Self-directed learning modules see Blackboard
Feedback from clinical teachers
BCS guide in the Resources Section of this handbook outlines required coverage.
Patient and Doctor

The PD competencies grid (see Resources Section) outlines coverage required by students. It is your
responsibility to ensure full coverage and seek feedback from tutors and supervisors.
Population Medicine
Feedback in structured teaching through discussion, e.g., Clinical Reasoning Sessions.
Personal and Professional Development

Feedback in structured teaching through discussion and from supervisors and tutors.
Summative Assessments covering all Themes

Day (week) Location Exam Final Comments
weight
Your examiner and time will be allocated to you by the

Clinical School where you will be during weeks 6 & 7.
Physical examination OSCE (8 minute) in:
By 5pm Ward, N/A
Physical Cardiology
Wednesday outpatients or (must
examination Respiratory or
(week 7) rooms pass)
Gastroenterology
NB: it is your responsibility to return your PE marking sheet
to CHW Clinical School by 5pm on Wed of week 7
40 questions (short answer written) 40 minutes
Clinical task
40
Main campus paper
On Monday
SRH=Dubbo*
(week 8) 60 questions (EMQ & SBA types) 90 minutes
and Orange*
MCQ paper 60
3 OSCE stations (8 minutes each):

On CHW
Wednesday - History
OSCE 30
(week 8) SRH=Dubbo* - Communication
or Orange* - Procedure/Practical skills
MCQ + CTP + 3 (or 4) OSCE stations
On Friday Further (NB: Physical exam station does not need to be redone if
CHW only** NA
(week 8) assessment previously satisfactory).
* School of Rural Health (SRH) students sit the MCQ and Clinical task papers at their SRH Clinical School (i.e., both Dubbo
and Orange), then sit the OSCE on Wednesday at one of those sites (i.e., either Dubbo or Orange). The group needing to
travel will be notified at the start of the block.
** All further assessments are conducted at CHW.
Final Paediatric mark
CAH Block mark 70% As above
End of Year Barrier Exam MCQ paper 30% 60 questions (EMQ & SBA types)

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To be classed as satisfactory for the CAH Block:
1. Students must pass the physical examination station
Students who are not satisfactory on their initial physical examination assessment can re-attempt the station.
A completed Physical Examination form showing that the student was satisfactory must be submitted to The Childrens
Hospital at Westmead Clinical School by 5pm Wednesday of week 8, otherwise the student will be required to complete a
further assessment for the physical examination on Friday of week 8 (when further assessments are held). If the student is
not satisfactory at the further assessment examination on Friday of week 8, they will be required to repeat the block.
2. Students must reach the pass mark* for the combined mark of the MCQ, CTP and OSCE (see above weighting)
3. Students must meet all PPD and required formative assessments and the Student Statement of Expectations
Results
*The CAH block pass mark is usually 78/130. However, the exact pass mark for your block is determined by CAH academic
staff, based on an assessment of the difficulty of the questions in the assessment for your block compared with previous blocks.
The University grading is only applied once you have demonstrated the required level of competence (please refer to COMPASS:
http://smp.sydney.edu.au/compass/assessment for details).
Notification of results:
1. Students who are not satisfactory will receive an individual email (usually by 6pm on Wednesday of week 8)
advising that they are required to attend a further assessment on Friday.
2. Then a generic email is sent to inform all students that students requiring a further assessment have been
notified. Your final mark and feedback sheet is created by the Assessment Office and provided via a link (this
is usually available by the end of week 8).
We are unable to provide individual feedback on exam performance except for students who are required to
complete a further assessment.
Reassessment for in-block summative assessment (i.e., further assessment)

Students who have not achieved the pass mark for the block may be offered a further assessment examination at the discretion of
CAH Speciality Block Academic staff. Further assessments are held on the Friday of week 8. The decision to offer a further
assessment will be based on the students performance over the block and may also take into consideration any or all of the
following: attendance; feedback from CRS and bedside tutors; and the proximity of the mark to the block pass mark.
All further assessment examinations will be held at The Childrens Hospital at Westmead. Therefore, students from the School of
Rural Health locations will need to travel to Sydney to attend the reassessment on the Friday of week 8.
Students offered a further assessment examination will usually be required to complete all components of the assessment. The
further assessment pass mark is always 78/130 (as we use past questions with known performance and difficulty levels).
Please note: the further assessment examination CANNOT be rescheduled and a student will be required to repeat the entire 8-
week block and assessments if they do not satisfactorily complete the further assessment examination during the scheduled
period. Therefore, it is recommended that students DO NOT book any domestic or international travel on the final Thursday or
Friday of the block. Students who miss the CAH examinations due to illness or misadventure, may be offered the opportunity to
take a delayed examination.
Students who pass the further assessment examination will have the mark from their first attempt recorded for the purposes of
grading unless they have an approved special consideration.
Students who do not pass the further assessment examination will be required repeat the CAH block.
Personal and Professional Development (PPD)

Students have to meet the following PPD requirements in order to receive a satisfactory result for this block:
Meeting attendance requirements consistent with the SMP attendance and leave policy at
http://sydney.edu.au/medicine/current-students/pdfs/Attendance_Leave_SMP.pdf
Active participation
Meeting NSW Health Code of Conduct
http://www0.health.nsw.gov.au/policies/pd/2015/pdf/PD2015_035.pdf
Ethical and professional behaviour (as outlined in Student Statement of Expectations)
http://sydney.edu.au/medicine/future-students/pdfs/expectations-statement.pdf
Special Consideration: please see Compass Stage 3 documentation from Assessments: you MUST class the CAH
Assessment as a Placement in order to ensure rapid review, otherwise processing will be delayed and you will miss
the resit opportunity on Friday of week 8. CAH does not automatically approve special consideration applications.

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Resources Section
Resource 1: Patient Doctor Competencies
Clinical Diagnosis
Competency & Specific Skills Assessment Learning mode
Obtain a full history for a child of different ages (i.e. preschool child, school age & adolescent) Formative: supervisor feedback Clinical attachments
Summative: OSCE Medical tutorials
Demonstrate skills of engaging, interviewing and taking a history from parents /carers and children (where appropriate) Revision from years 1 & 2
Obtain comprehensive information from parent/carer.
Demonstrate appropriate skills and techniques in history taking from parents/carers
Demonstrate appropriate skills and techniques in clinical history taking from adolescent, incl. psychosocial history
(HEADSS)
Demonstrate appropriate use of the Personal Health Record (blue book) of a child for accessing information about Formative: supervisor feedback Clinical attachments
previous illnesses, growth parameters and immunisations Summative: OSCE Medical tutorials
Revision from years 1 & 2
Demonstrate familiarity with Personal Health Record
Demonstrate competence in accessing and interpreting information
Perform examination of a child at different ages (i.e. preschool, school age & adolescent Formative: supervisor feedback Clinical attachments
Summative: OSCE Medical tutorials
Explain purpose, consent issues and obtain permission for examination
Demonstrate sensitive and opportunistic approach to examination of a young child
Demonstrate possible strategies which can be used to examine the uncooperative or distressed child
Measure and plot on chart head circumference, weight and height for an infant, older child and adolescent.
Ensure correct use of equipment (e.g., positioning of tape on head)
Calculation of Body Mass Index (BMI)
Examine whole child, including mouth, teeth, throat, skin, joints, eyes and ears etc
Demonstrate competence in developmental, gastrointestinal, respiratory and cardiovascular examinations
Demonstrate competence in diagnosing cardiac lesions through auscultation
Understand system-specific examinations: haematological, neurological, endocrine, renal
Conduct a thorough and sensitive physical examination including Tanner staging of pubertal development
Recognise common medical conditions, developmental disorders, pubertal alterations in an adolescent
Demonstrate awareness of issues in examination of child and adolescent at risk Formative: supervisor feedback Clinical attachments
Summative: OSCE Child at risk session
Recognition of non-accidental injury (NAI), neglect, and its effects and your medico-legal obligations
Recognition of adolescent at risk for depression and suicide
Recording of examination findings
Take a childs temperature and record on chart Formative: supervisor feedback Clinical attachments
Summative: OSCE
Demonstrate use of different methods/sites
Measure BP (including use of non-electronic sphygmomanometer) and plot on chart for 1) infant and 2) older child Formative: supervisor feedback Clinical attachments
Summative: OSCE
Choose appropriate cuff size
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Determine systolic and diastolic blood pressure and plot result on an observation chart
Perform ear examination using auroscope/otoscope and pneumatic otoscopy Formative: supervisor feedback Clinical attachments
Summative: OSCE
Demonstrate correct technique, positioning and hold
Demonstrate correct technique of delivering puff of air and watching eardrum with pneumatic otoscopy
Demonstrate sensitive and opportunistic approach to examination with young children
Perform an assessment of a child for squint Formative: supervisor feedback Clinical attachments
Summative: OSCE
Demonstrate correct technique
Recognise age appropriateness for technique
Recognise limitations of technique
Measure blood glucose using a glucometer Formative: supervisor feedback Clinical attachments
Summative: OSCE
Correct use of stylet
Correct use of glucometer
Demonstrate correct management for hypoglycaemia and hyperglycaemia
Perform oximetry and recognise its limitations Formative: supervisor feedback Clinical attachments
Summative: OSCE
Correct use and positioning of equipment
Demonstrate understanding of effect of peripheral blood flow on results
Measure peak expiratory flow and plot on chart Formative: supervisor feedback Asthma management workshop
Summative: OSCE Clinical attachments
Recognise age appropriateness for peak flow measurement
Use and encourage child to use appropriate technique to ensure accuracy
Interpret peak flow
Understand principles of spirometry Formative: supervisor feedback Asthma management workshop
Summative: OSCE Revision Year 1
Recognise age appropriateness (approx.. >7 yrs) for spirometry Clinical attachments
Know appropriate technique to ensure accuracy
Observe lumbar puncture Formative: supervisor feedback Clinical attachments
Summative: OSCE
Demonstrate knowledge of procedure
Demonstrate understanding of safety with infants and children
Demonstrate understanding of correct collection, storage and transport
Perform urinalysis Formative: supervisor feedback Clinical attachments
Summative: OSCE Revision from ICAs
Use correct technique
Record accurately
Interpret from patient notes/investigation results
Assess minor burns and keloid scarring Formative: supervisor feedback Clinical attachments
workshop teacher feedback Burns session
Perform correct initial treatment/ first aid Summative: OSCE
Demonstrate knowledge of when to refer
Perform routine immunisation Formative: supervisor feedback Clinical attachments
Summative: OSCE and Clinical Immunisation procedural skills station
Demonstrate understanding of schedule task paper
Choose appropriate site, equipment and technique

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Investigations
Interpret and discuss XR chest, abdomen, skull, hips, long bones Formative: supervisor feedback Clinical attachments
Summative: MCQ, Clincal task Clinical reasoning
Demonstrate systematic approach paper and OSCE Imaging sessions
Obtain key information re name, date, position, cardiac shadow, lung tissue, soft tissue, bones as relevant Demonstrate Revision Stage , core blocks
understanding of normal and important abnormal findings including fractures
Interpret and discuss CT scan of head Formative: supervisor feedback Clinical attachments
Summative: MCQ, Clinical task Clinical reasoning
Demonstrate systematic approach to process paper and OSCE Imaging sessions
Obtain key information: major abnormalities or asymmetry of findings Revision Stages 1/2
Demonstrate understanding of normal and important abnormal findings
Interpret basic results (e.g., full blood count and film, biochemisty, blood gas) Formative: supervisor feedback Clinical attachments
Recognise normal values for children of different ages paper and OSCE Revision Stages 1/2
Recognise important abnormal findings
Recognise important features from blood film
Recognise some important abnormal patterns e.g., neonatal jaundice, acute renal failure
Interpret spirometry graphs Formative: supervisor feedback Clinical attachments
Recognise age appropriateness (approx. >7 yrs) for spirometry paper and OSCE Revision Stages 1/2
Know appropriate technique to ensure accuracy Common respiratory disorders
Recognise patterns in spirometry curve overview lecture
Asthma management workshop
Interpret results of routine pulmonary function report Formative: supervisor feedback Clinical attachments
Summative: MCQ, Clinical task
Recognise normal as well as abnormal patterns in pulmonary function tests paper and OSCE
Interpret microbiological analyses of specimens of urine, blood, stool, sputum, nasopharyngeal aspirate and Formative: supervisor feedback Clinical attachments
cerebrospinal fluid Summative: MCQ, Clinical task Clinical reasoning
paper and OSCE Revision Stages 1/2
Recognise normal findings
Recognise common abnormal conditions
Collect specimens for microbiological examination (e.g.,urine, throat swabs, nasopharyngeal aspirates, skin swabs) Formative: supervisor feedback Clinical attachments
Summative: OSCE Catheterisation station
Use appropriate and safe procedures
Understand importance of correct procedures re transport/storage
Perform urinary catheterisation of infants
Observe suprapubic bladder tap
Explain procedures clearly to child and parents/carers

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Management and Communication
Calculate and chart a paediatric medication order Formative: supervisor feedback Clinical attachments
Calculate correctly using weight or surface area paper and OSCE Palin Workshop
Recognise and use sources of recommended dosages
Chart correctly
Calculate and chart a fluid order Formative: supervisor feedback Clinical attachments
Estimate oral fluid intake required for rehydration paper and OSCE Fluids session
Calculate and chart fluid requirements for child requiring intravenous fluid therapy Burns session
Calculate and chart appropriately for burns patients Trauma session
Calculate and chart appropriately taking into account shock
Reconstitute an oral electrolyte/rehydration solution Formative: supervisor feedback Clinical attachments
Summative: MCQ, Clinical task Fluids session
Follow instructions paper and OSCE
Use appropriate measures
Instruct a child and/or parent in the use of a variety of age appropriate devices for asthma medication delivery Formative: supervisor feedback Clinical attachments
Summative: OSCE Asthma management workshop
Demonstrate knowledge of age appropriate devices
Demonstrate knowledge of medication appropriate devices
Convey information in appropriate language to parent/carer & child
Convey information about investigations required and investigation results Formative: supervisor feedback Clinical attachments
Summative: OSCE & Clinical task Clinical reasoning
Convey information in appropriate language paper
Convey information with accuracy, based on evidence
Verify patient/parent/carer understandings
Convey information to parent about immunisation schedule, indications and contraindications Formative: supervisor feedback Clinical attachments
Summative: OSCE Immunisation procedural skills station
Demonstrate knowledge of schedule
Demonstrate knowledge of contraindications
Make entry into the Personal Health Record (e.g. Blue Book) re: Immunisation, Accident & Emergency visits, Formative: supervisor feedback Clinical attachments
Hospitalisations & Growth charts Summative: OSCE Immunisation procedural skills
Write legibly
Enter relevant information concisely in appropriate sections
Date & Sign
Observe IV cannulation Formative: supervisor feedback Clinical attachments
Summative: OSCE Skills session
Knowledge of correct technique

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Perform cardiopulmonary resuscitation in children of all ages Formative: supervisor feedback Clinical attachments
Summative: OSCE BLS procedural skills session
Demonstrate correct technique
Demonstrate knowledge of correct equipment
Understand different procedures for different ages
Perform advanced airway support (on manikin) using Guedel, bag and mask, endotracheal intubation
Perform intra-osseous needle insertion (on model/manikin) Formative: supervisor feedback Clinical attachments
Summative: OSCE IO procedural skills session
Demonstrate correct application of rigid cervical collar (on model/manikin) Formative: supervisor feedback Clinical attachments
Summative: OSCE C Spine procedural skills session
Clean and dress wounds and minor burns Formative: supervisor feedback Clinical attachments
Summative: OSCE Burns session
Correct choice of dressings
Correct and safe procedures
Application and care of plasters Formative: supervisor feedback Clinical attachments

Summative: OSCE
Correct procedure
Assessment of tightness
Make up an infant milk feed Formative: supervisor feedback Clinical attachments
Summative: OSCE
Correct proportions & correct temperature
Hygienic technique
Age appropriateness
Change a nappy Formative: supervisor/parent Clinical attachments
Provide information to families and carers of chronically ill and disabled children Formative: supervisor feedback Clinical attachments (esp. community
Summative: OSCE and Clinical placements)
Sensitively convey information re medical conditions and management (e.g., prolonged treatment, invasive tests, task paper Clinical reasoning
appropriate use of antibiotics)
Demonstrate awareness of support services, allied health professionals and know when to refer
Provide simple explanations of common conditions to parents and children, including: asthma, croup, gastro Formative: supervisor feedback Clinical attachments
intestinal illness, febrile fits, otitis media, URTI Summative: OSCE and Clinical Revision year 1 & 2
task paper
Convey information appropriate to levels of understanding in appropriate language (no jargon)
Demonstrate understanding of communicating with families from disadvantaged backgrounds and from non-English
speaking backgrounds (of different cultural, ethnic or religious background)
Demonstrate ability to provide feedback to an adolescent and collaboratively develop a care plan Formative: supervisor feedback Clinical attachments
Summative: OSCE and Clinical
task paper
Convey verbal and written information to health professionals & other interested parties Formative: supervisor feedback Clinical attachments
Summative: MCQ, Clinical task
Demonstrate ability to communicate effectively and accurately re ongoing care, management plans and responsibilities paper and OSCE
Understand responsibilities re notification of children at risk
Demonstrate awareness of the issues in ongoing care for children of families living in rural and regional areas and the
medical management difficulties for these families

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Resource 2: A Guide to CAH Basic and Clinical Sciences
BCS summative assessment samples from BCS coverage across the full four years of the Syndey Medical School,
including clinical reasoning and related learning, structured teaching sessions and self-directed learning covering all
topics listed below. BCS coverage from Years 1 and 2 is assumed knowledge. Relevant paediatric and adolescent
cases from Years 1 and 2 are on the list at the end of this document.
GENERAL CHILD & ADOLESCENT TOPICS
Evidence Based Medicine:

Well-structured clinical questions in paediatrics
Epidemiological principles, methods and applications
Systematic Reviews and Evidence Based Guidelines appraisal and applications within Child and Adolescent Health
Normal development and developmental problems:

Developmental milestones (ages 1 5 years) and stages of childhood and adolescence
Delayed walking
Delayed speech
Hearing and vision problems
Normal developmental concerns sleep, feeding, tantrums etc
Aetiology of global developmental delay
Definition and aetiology of cerebral palsy
Behaviour problems including ADHD
Autism
Growth and nutrition:

Normal growth and pubertal development
Fat metabolism and nutrition
Energy needs and expenditure in children and adolescents
Failure to thrive
Breast milk, breast milk substitutes and introduction of solids
Lactose intolerance and cows milk protein intolerance
Malabsorption, incl. coeliac disease
Eating disorders
Obesity in childhood and adolescence
Antecedents of adult disease
Common acute presentations: recognising and managing the sick child

viral and bacterial infections
asthma
abdominal pain
vomiting
fever in children
headaches
poisoning/ingestions
paediatric trauma (see surgical topics listed below)
Children and adolescents at risk:

Patterns of injury, including neglect and sexual abuse
Long term effects of child sexual assault and non-accidental injury
Depression and suicide
Risk-taking behaviours including drug abuse, alcohol, smoking
Infectious diseases in childhood from a global and regional perspective:

Natural history of preventable diseases
Vaccine preventable diseases
Fever and rash (including viral exanthema, petechial rash), lymphadenopathy
Antibiotic use
Types of vaccines and potential vaccines

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Immunisation:
Immunisation schedule, including catch up schedules
Indications/contra-indications for immunisations
The immunocompromised child
Immunological problems in childhood:

Immunology of allergy
Clinical presentations of allergy
Mechanisms of therapy
Immune deficiency recognition
Kawasakis disease
Henoch Schonlein purpura
Acute sepsis in children:

Differential diagnoses including meningitis, septicaemia
Significance of rash in meningitis/sepsis
Recognition of the seriously ill child or adolescent.
Cerebrospinal fluid physiology and clinical relevance
Management of meningitis and acute sepsis
Clinical genetics:
Principles of DNA diagnosis and linkage
Inherited disorders including PKU and CF
Classic syndromes (e.g., Down syndrome, Turners, Noonan, Velocardiofacial syndrome)
The dysmorphic child:

Recognition of clinical phenotypes, including Down syndrome, Turner syndrome
Diagnostic methods
Common early dental problems:

Normal dental development
Important abnormal development
Emergency treatment including dental trauma
Oral hygiene and prevention, including recognition and prevention of bottle caries
Paediatric dermatology - common presentations:

eczema
congenital naevi and haemangiomas
skin infections and infestations
acne
skin manifestations of systemic disorders (e.g. , SLE, NF)
Common eye problems in childhood:

Strabismus/amblyopia
Eye infections
Conjunctivitis
White pupil
Nasolacrimal duct obstruction
Eye injury
Common ENT problems:

Ear infections in children acute otitis media, glue ear, tonsillitis
Snoring, stridor
Foreign bodies
Impaired hearing and speech development - early diagnosis
Respiratory disorders in childhood:

Acute and chronic respiratory problems in childhood and adolescence: pathology, presentations, management
Anatomy of infant and child airways.
Pathophysiology of airway obstruction.
Recognition of severity of respiratory distress in infants and children.
Asthma clinical assessment and management, including asthma management plan, medications: relievers and preventers
Cystic fibrosis
Congenital heart disease: cyanotic and non-cyanotic

Heart failure in infancy.
Common congenital heart defects
Significance of cardiac murmur in neonate
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Innocent cardiac murmur
Gastroenteritis:
Differential diagnoses of vomiting and diarrhoea
Assessment of dehydration
Fluid management
Chronic gastrointestinal conditions in children:

Constipation
Chronic diarrhoea
Somatisation of symptoms
Jaundice in children:
Types of jaundice (conjugated and unconjugated hyperbilirubinaemia)
Associated problems/complications
Investigations
Biliary atresia
Important renal problems in children:

UTI
Congenital malformations
Enuresis
Protein/blood in urine, including nephrotic syndrome
Renal transplant
Childhood seizures and other neurological conditions

Classification of seizures in childhood including epilepsy and febrile seizures
Development of the CNS including normal development and antenatal and postnatal insults
Management of initial epileptic seizure or febrile seizure
Spina bifida
Cerebral palsy
Hydrocephalus
Headaches in childhood
Paediatric endocrinology:
Stature tall and short child and adolescent including Turner syndrome, pituitary disorders
Diabetic in children and adolescents
Normal pubertal onset and development
Paediatric haematology:
Diagnosis and management of anaemia in children
Compensatory mechanisms
Bleeding and bruising in children
Paediatric oncology:
Genetic bases of malignancy
Syndromes associated with malignancy
Immunosuppressed child in the community
Leukaemias
Solid tumours in childhood
Sudden Infant Death Syndrome (SIDS):

Causes and prevention
Respiratory physiology
Apnoea in childhood
Rheumatic disease in children:

Acute and chronic arthritis
Juvenile idiopathic arthritis
Less common rheumatic diseases e.g. juvenile dermatomyositis, SLE and scleroderma

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PAEDIATRIC SURGICAL TOPICS
General paediatric surgery:

Childhood physiology and anatomy
Surgical management of fluid loss
Congenital conditions requiring surgery
Infections and inflammation
Bilious and non-bilious vomiting
Pyloric stenosis, duodenal atresia, malrotation, intestinal atresia and anorectal anomalies, necrotising enterocolitis, Hirschsprungs
disease, Meconium ileus
Appendicitis and differentials, intussusception
Acute and chronic neck lumps
Inguino-scrotal disorders in children hernia, hydrocele, undescended testes, testicular torsion
Penile disorders, circumcision
Burns:
Thermal damage/pathophysiology of burns
Principles of management including first aid treatment
Fluids and electrolytes
Safe transport
Inhalation burns
Trauma:
ABC assessment/ treatment
Similarities/differences children compared with adults: weight, physiology, psychology
Normal fluid balance in children and fluid management
Appropriate investigations
Specialist paediatric surgery:

Headaches and raised intracranial pressure (incl hydrocephalus)
ENT (see also Common ENT Problems - above)
Aspirated foreign bodies
Management of pigmentary and other skin lesions
Diagnosis of fractures
Gait and postural abnormalities
Pain management in children
Common plastic surgery application cleft palate, wound repair
Common paediatric orthopaedics:

Common childhood fractures
Septic arthritis/ osteomyelitis
Knock knee, bow legs, flat feet
Syndromes: congenitally dislocated hip, Perthes disease, Osgood-Schlatter disease, slipped upper femoral epiphysis
Acute joint swelling:

Pathophysiology of joint inflammation
Classification of joint swelling in children
Arthritis in children
Pain management in childhood:

Physiology of pain
Appropriate therapies including self-medication (patient controlled analgesia)
Acute post-operative pain management
Medical imaging in paediatrics:

Use of imaging in common paediatric presentations
Radiological features of common paediatric presentations
Imaging methods

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Resource 3: PBL Cases from Years 1 and 2 Assumed Knowledge for CAH
Specialty Block
Title Description
1.07 Dont tell my mother 16 y.o. - vaginal discharge incl. sexuality and consent issues.
1.10 Weighing up the risks 14 month with rash, not immunised
2.01 New wheels Young male - motor cycle accident risk taking in adolescence and early adulthood
3.02 Wheezing and breathless 1 y.o. child with asthma
3.07 Difficult circumstances 23 month old Aboriginal child with ear and respiratory infections
4.03 A swollen knee 14 month old with bleeding disorder
4.04 Pale and feverish 6 y.o. boy with intermittent fever: thalassaemia/malaria
5.05 Jennifer and Davids baby 8 week old child with Down syndrome and cardiovascular abnormalities
6.02 Jason and Brook Epilepsy (mother) and baby with spina bifida and hydrocephalus
6.04 My head hurts 4 y.o. with brain abscess and meningitis
7.02 Problems at school Pituitary tumour (13 y.o.)
7.03 Unwell and unhappy Steroid excess in asthma management (15 y.o.)
7.04 They mustnt find out Insulin dependent young adult, including endocrinology topics and compliance
issues
8.04 Swollen ankles Not a paediatric case (nephrotic syndrome) but relevant to paediatric patients
9.02 Im not a hundred per cent Young adult with coeliac disease (includes chronic illness in adolescent years)
9.03 Small and sickly 6 month old failure to thrive

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Resource 4: Recommended Texts
Main References
"Practical Paediatrics"
(Churchill Livingstone, 7th Edition 2012) M South & D Isaacs
"Consulting with Children"
(W B Saunders, 1989) I C Lewis, R K Oates & M J Robinson
"Jones Clinical Paediatric Surgery"
th
(Blackwell, 6 Edition 2008) J Hutson, M OBrien, A Woodward & S Beasley
"Rudolphs Fundamentals of Paediatrics"
rd
(Lange, 3 Edition 2002) A M Rudolph & R K Kami (Eds.)
Additional References
https://www.spottingthesickchild.com UK Department of Health website
Atlas of Pediatrics: Physical Diagnosis
th
(5 Ed 2007) BJ Zitelli, HW Davis & M Wolfe
"Paediatrics Manual, The Children's Hospital at Westmead
nd
Handbook 2 Ed. H Kilham, S Alexander, N Wood & D Isaacs (Eds.)
(2009)
"Developmental-Behavioural Pediatrics"
rd
(W B Saunders, 3 Ed. 1999) M Levine, W Carey & A Crocker
Essential Paediatrics, 4th Ed.
(Churchill Livingstone, 1999) D Hull & D Johnston
Illustrated Textbook of Paediatrics
rd
(Mosby, 3 Ed. 2007) T Lissaue & G Clayden
Mosbys Color Atlas and Text of Paediatrics and Child
Health (Edinburgh 2001) B Chaudhry & D Harvey
"Nelsons Textbook of Paediatrics" 19th Ed.
(W B Saunders, 2011) R E Behrman (Ed.)
"Nelsons Essentials of Paediatrics" 6th Ed.
(W B Saunders, 1998) R E Behrman & RM Kleigman (Eds.)
"Pediatric Medicine" 2nd Ed.
(Williams & Wilkins, 1993) M E Avery & L R First
"Rudolphs Pediatrics" 22nd Ed.
(Appleton & Laned, 2011) A Rudolph (Ed.)
The Surgical Examination of Children (Heinemann, Oxford,
1988) J M Hutson & S W Beasley
"The Normal Child" 9th Ed.
th
(Churchill Livingstone, 10 Ed. 1994) R S Illingworth
Paediatrics, An Illustrated Colour Text, International Ed.
(2002) D Field, J Stroobant, et al
Paediatrics: Understanding Child Health
(Oxford, 1997) T Waterson, P Helms & M Ward Platt
nd
Paediatrics at a glance, 2 Ed (Blackwell 2007) L Miall, M Rudolf, M Levere
th
Pediatrics secrets 5 Ed (Mosby/Elsevier 2011) R. Polin, M. Ditmar
A Clinical Handbook on Child Development Paediatrics S Johnson (Ed.)

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Resource 5: Adolescent Medicine
Adolescent Medicine is a relatively new specialty compared to Paediatrics and Adult Medicine. Adolescents appear in many parts
of the health system, and for medical students definitely not just in their paediatric block. Adolescence is defined as the second
decade of life. It is a time of major psychosocial change as well as the physical changes of puberty. Given that the brain does not
reach full development until the middle of the third decade, many of the risk taking behaviours which are related to immaturity of the
frontal cortex with poor impulse control and failure to accurately judge risk are also part of young adulthood. In fact, combining
adolescent with young adult medicine makes good developmental sense and the age groups share many similar morbidity and
mortality risks. Adolescents and young adults have featured in PBLs in the first two years, including risk taking in a motor bike rider
(2.03 New wheels) and iatrogenic Cushings syndrome (7.03 Unwell and unhappy). Male and female puberty was covered in Block
7 and review of these lectures is also recommended.
Falling through the cracks: young people are often diluted in the adult health care system, especially with an ageing and sick
population as a result of increased life expectancy. Young people often fall through the cracks: too old for paediatricians, too young
for adult physicians, and perhaps mistrustful, at times, of the family general practitioner, particularly if they wish to discuss
confidential issues which they are concerned may get back to their parents. Consequently, many of their concerns and problems
tend to go unnoticed and adolescents are often unlikely to speak out about health concerns, especially if they think that they will
appear stupid for asking. In your paediatric rotation it is important to observe and understand some of the cultural and treatment
differences between adult and paediatric hospitals, as this will help better understanding of the difficulties associated with transition
to adult care in chronic illness and of engaging adolescents in their own health care.
Mortality and conventional morbidity are relatively low among young people compared to older age groups. However, for
adolescents there has been a worsening across a range of indicators of health and wellbeing over the past three decades, despite
the dramatic changes to medical care over that time. The major health problems experienced by adolescents are in part the
consequences of behavioural, social and environmental factors. In this is included mental health and risk-taking behaviour
Many young people do not reach their full potential as adults because of premature mortality and morbidity associated with
unintentional injury, suicide and violence. Other adverse health consequences are strongly related to substance use and misuse,
unwanted pregnancy and sexually transmitted infection, and physical inactivity and poor nutrition with consequent overweight and
obesity persisting into adult life. The incidence of mental health problems rises sharply from mid-adolescence, although less
frequently diagnosed. Seventy five percent of adult mental illness has its origins in adolescence and if inadequately treated early on
may progress to chronic adult incapacity.
Advances in medical and surgical care mean that many sufferers of chronic childhood illnesses now survive into adulthood, and
that conditions which were once only seen in childhood now regularly present for adult care. There is also an actual increase in the
prevalence of chronic illness, including Type 1 diabetes and inflammatory bowel disease. Both these scenarios mean that adult
services need to better understand presentation and management of chronic illness in younger age groups, including its impact on
fertility and reproduction, and on the capacity to work and lead a fulfilling adult life.
Understanding adolescent medicine.

1. Puberty or difficult behaviour should not be assumed to be the root cause of most adolescent health presentations.
Adolescents may often present differently to other age groups. Doctors have something special to offer young people: by
being accessible to them; by understanding the dramatic developments in both their bodies and minds; by recognising the
intimate relationship between their health and behaviour; and by making every effort to encourage their self-responsibility.
The goal is to assist young people to achieve good health, reasonable fitness, emotional stability, and the capacity to
cope with challenges and opportunities. Whatever the presenting complaint or concern, an encounter with an adolescent
patient presents the clinician with an opportunity for broad-based assessment, timely prevention and intervention.
2. That it takes time to establish rapport with adolescents (who are often not forthcoming), as well as taking a full history and
negotiating the physical examination limits. An effective medical interview not only collects information, but also sets the
tone for future interactions. There are several interrelated steps: establishing a relationship of trust; obtaining an inventory
of concerns and priorities for the young person; and determining their individual risk profile. There may also be
opportunities to provide developmentally appropriate education and to support the young person's decision making. The
paediatric rotation is an excellent time to practice the HEADSS interview, a semi structured format which works from less
sensitive to more sensitive psychosocial issues. A well done HEADSS interview will take 40-60 minutes.
3. Adolescent medicine is largely a multidisciplinary endeavour with best practice almost always meaning a teamwork
approach (which is of course true of many other specialties where medicine, nursing and allied health work together to
achieve the best outcome). Medical students can learn a lot from the non-medical team members and they can also learn
how to effectively work with parents and schools. These are two of the most important aspects of a young persons life
and have a powerful influence on resilience and making healthy choices.
The Royal Australasian College of Physicians is currently going through the process of acknowledging and offering training in
adolescent and young adult medicine.

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"Good medical care of adolescents does not depend on the specialty of the provider, but on the sensitivity
of the physician to the enormous physical and psychological changes that are taking place during the
teenage years."
CE Rapp (1983) Annals of Internal Medicine.
Lecture and self-directed learning topics in adolescent health:

Developmental perspective on adolescence
The health care of young people
Clinical approach to the adolescent patient
Recognising the adolescent at risk
Impact and management of chronic illness in adolescence
Lifestyle and precursors of adult disease
Adolescent sexual and reproductive health
Integration of the themes of the course:

BCS - revisiting physiology of puberty, nutrition, organic pathology
PPD - understanding adolescence in a societal context, relationship between health and behaviour, taking a holistic
view, approaching sensitive issues
CDT - continuity of care, shared care, transition care
Pt-Dr - developing essential interview, assessment and management skills
Integration of adolescent health with the CAH Specialty Block:

Dedicated clinical placements in adolescent health (for some students)
Clinical reasoning e.g., adolescent with a chronic illness
Clinical exposure options in adolescent medicine:

Involvement with adolescent inpatients
Involvement with adolescent outpatients in general and sub-specialty clinics
Participation in an outreach service at a community youth health centre (for some)
References:
Adolescent Health GP Resource Kit, Second Edition, The Children's Hospital at Westmead:
http://www.caah.chw.edu.au/resources/gpkit/Complete_GP_Resource_Kit.pdf
Goldenring JM & Adelman WP 2014.
Goldenring, J. and Rosen, D. 2004. Getting into adolescent heads: an essential update. Contemporary Pediatrics,
21(1):64.
Adolescent development D Christie and R Viner BMJ 2005;330:301 First in a series of 12 entitled the ABC of
Adolescence
Rebecca R S Mathews, Wayne D Hall, Theo Vos, George C Patton and Louisa Degenhardt. What are the major drivers of
prevalent disability burden in young Australians? MJA 194:1-4
Sturrock T, Masterson L, Steinbeck KS 2007 Adolescent Appropriate Care in an Adult Hospital; The use of a Youth Care
Plan. AJAN 24: 49-53
Pfeifer JH. Masten CL. Moore WE 3rd. Oswald TM. Mazziotta JC. Iacoboni M. Dapretto M. Entering adolescence:
resistance to peer influence, risky behavior, and neural changes in emotion reactivity. Neuron. 69(5):1029-36, 2011

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Resource 6: Medical Bedside Tutorials
The following history and physical examination topics are to be covered in 6 one-hour tutorials: Your bedside tutor will find the first
patient, and then for the remainder of the tutorials, each student in the group will take turns finding a patient for the tutorials.
Tutorial 1: Introduction
History taking and a general examination approach in children. These aspects should be incorporated as appropriate into the
subsequent tutorials on specific system examinations. (NB Students submit a structured written history as a required formative
assessment, on Monday of Week 5 Guidelines are at the end of the Resources Section.)
Tutorials 2 to 5: There are four systems which make up the core content for tutorials 2 5 inclusive:
1. Developmental
2. Respiratory
3. Gastrointestinal
4. Cardiovascular examination
Tutorial 6: Final review of paediatric history-taking and physical examination

An overview of each system is presented below, with more detailed examination findings in the following pages. Students are
expected to find appropriate patients for each tutorial except for the first tutorial in Week 1, in which the tutor will find a patient.
Developmental
General-growth, dysmorphism, behaviour
Vision
Hearing
Fine motor
Gross motor
Speech and Language
Personal/Social
Respiratory Examination
General-growth, dysmorphism, well/unwell, supplemental oxygen, cough, temperature
Colour - cyanosed or not cyanosed
Peripheral findings of respiratory disease
Respiratory noises
Respiratory distress-accessory muscles
Chest deformity
Auscultation findings
Ear, nose and throat
CXR
Gastrointestinal Examination
General-growth, dysmorphism, nutrition
Jaundiced or not jaundiced
Peripheral findings suggestive of chronic liver disease/bowel disease
Abdomen-liver disease, liver failure, portal hypertension, other (e.g. renal)
Perianal findings (inflammatory bowel disease)
Colour of urine and stool
Cardiovascular Examination
General-growth, dysmorphism, well/unwell, supplemental oxygen
Peripheral findings of heart disease
Cyanotic or not cyanotic
Heart failure or not heart failure
Praecordial findings
CXR and ECG (basic)

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Paediatric History Taking A suggested Approach
DEMOGRAPHICS
Age, sex, position in family, place of residence, ethnicity
ANTENATAL HISTORY
Can be obtained from Personal Health Record (e.g., in NSW the Blue Book)
Delivery vaginal / elective or emergency caesarean, Gestational age,
Birth weight / length / head circumference, Apgar scores at 1 and 5 minutes, Birth place
Postnatal course were they jaundiced/did they have feeding difficulties/did they needed oxygen?
MEDICAL PROBLEMS
Past illness (presenting problems and management)
Present illness (presenting problems management)
Symptoms for specific systems:
Developmental/Neurological seizures, deterioration in milestones (see development below), floppy, increase in muscle tone, hearing,
speech, attention and activity, vision (including squint)
Respiratory - breathlessness, wheeze, stridor, cyanosis, cough (day and night), sweating, fevers
Gastrointestinal - jaundice, diarrhoea (blood and/or mucous), constipation, PR bleeding, stool colour, vomiting (blood or bile),
abdominal pain, food intolerance, diet history (intake, appetite), nausea, loss of weight
Cardiovascular breathlessness, sweating, oedema, feeding difficulty, cyanosis
MEDICATIONS AND ALLERGIES

IMMUNISATIONS
Refer to Blue Book (e.g., Blue Book) and immunisation schedule.
FAMILY HISTORY
Consanguinity: are the parents related in any way other than marriage?
Draw family tree. (mother, father and children). Ask for family history of diseases and record these.
Garry age 40 Cheryl age 39

Mechanic Home duties
Epilepsy Asthma
Janine Tim Lucy Johnny

15yrs 12yrs 5yrs 2yrs
SOCIAL HISTORY
Occupation of parents
Year level at school, which school? hobbies (e.g. sports)
For adolescents, remember to take a HEADS (see resources in Adolescent section)
DEVELOPMENTAL LEVEL
Refer to a chart of developmental milestones see Page 30 for details.
Head circumference (refer to Blue Book - personal health record)
Are any interventions required? (e.g., Physiotherapy, Occupational therapy, Speech therapy)
Social interaction with family members and peers
Vision, Hearing
FEEDING AND NUTRITION

Breastfed (duration) / formula fed
Age of commencement of solids
Swallowing difficulties, vomiting
GROWTH
Weight gain or growth problems (refer to growth charts or personal health record/Blue Book)

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General Examination Approach to Children
A general examination approach is listed below. This is applicable to paediatric patients when examining single or multiple organ
systems. Flexibility in approach is necessary to accommodate the age and developmental stage of the child.
General
Environment
- Privacy
- Non-threatening (e.g. remove sharp objects)
Parents - Introduction
- Explanation of examination
- Gain confidence of child by rapport with parents
Child - Introduction and rapport with child
- May need to approach slowly
- Gain trust (e.g. examine childs toys)
- Exposure - Aim for best possible under the circumstances
- Positioning - bed or parental lap (as appropriate)
- Be aware of causing discomfort or pain (look at face)
Hands off inspection

Well or unwell
Alertness
Activity
Social responsiveness
Breathing- (e.g. use of accessory muscles)
Circulation-(e.g. pallor)
Vital signs (nursing charts)
*Growth parameters (parent records, growth charts)
Signs of system failure (e.g. liver failure)
Dysmorphic features
Behaviour (? age appropriate)
*It is essential to look at a growth chart during general inspection. This is a requirement in every clinical summative assessment.
Top to Toe Examination

Hands and Arms- nails, pulse, bruising
Head and neck- fontanelle, microcephaly, macrocephaly, sutures, shunt, bruits
eyes (e.g. squint), nose, mouth and ears (usually left until the end)
lymph nodes, thyroid gland
Chest - cardiorespiratory
Abdomen - liver, spleen, kidneys, ascites, masses
Groin and genitalia - hernias, nodes, pubertal stage
Back and Spine
Legs and gait

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Developmental Examination Suggested Approach
(NB refer also to General examination approach to children)
During developmental examination all the milestones mentioned below do not need to be memorised but key milestones for each area for
the first 4 years of life need to be known. The assessment of tone, power and reflexes of lower and upper limbs should be covered. Useful
resources include Table 2.2.2 Normal ranges in Roberton & South (2007) Practical Paediatrics; Table 8-1 Developmental milestones
and Figure 8-1 Denver Chart II in Nelson (2002) Essentials of Paediatrics; and Normal child development: Physical and developmental
from Stage 2 lecture pre-readings: http://smp.sydney.edu.au/compass/pbl/display/type/ta/activitytypeid/6/ref/6.04
http://smp.sydney.edu.au/compass/teachingactivity/view/id/768
GENERAL INSPECTION
Does the child look well or unwell
Growth: appropriate or not? Check growth parameters macrocephaly, microcephaly, short tall, failing to thrive?
Nutrition: are there any specific findings to suggest a nutritional deficiency?
Developmental observations: Note play and behaviour, quality (e.g., stereotypic movements of Autism, imaginative play)
Dysmorphic features (especially face & hands but can also be in other locations)
Other: Lines or tubes, O2, posturing from increased or decreased muscle tone, neurostigmata (e.g., neurofibromatosis)
VISION
Fix and follow light
Then test if can fix on progressively smaller objects
HEARING
Younger child: use the distraction test
Responds to bell at 2 months
Turns to bell at 4 months
Above 8 months: can isolate stimulus above and below the head
Older child: can whisper in ear and see if repeats words
NB *If you detect a major hearing problem check ear drums for glue ear at the end of the examination
FINE MOTOR
Using a cube/block Can grasp cube at 5 months
Transfer across mid-line by age 6 months
Bang 2 cubes together at 12 months
Grasp Palmar 6 months
Thumb finger grasp at one year
Using a raisin Thumb finger at 11 months
Neat pincer at 15 months
Crayon Scribbles at 2 years
Copies line at 3 years
Circle at 3.5 years
Cross at 4.5 years
GROSS MOTOR
In prone position head to 90 at 3 months
Rolls over at 4.5 months
Sits unaided at 6 months
Stands and weight bears at 6 months
Walks at 12 months
Goes up steps at 2 years of age
Jumps at 3 years of age
Stands on one foot at 3.5 years of age
Able to hop at 5 years of age
LANGUAGE
Vocalising at 2 to 3 months
Babbles 6 months
Imitates sounds at 12 months
Six words at 18 months
2-3 word sentences at 24 months
Knows plural by age 3 years
Colour by age 4 years
(continued over page)

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Developmental Examination Cont.
PERSONAL AND SOCIAL SKILLS

Smiles at 2-3 months
Shows likes and dislikes at 6 months
Plays peek a boo at 9 months
Comes when called at 12 months
Drinks from a cup at 16 months and uses a spoon at 24 months
TONE, POWER AND REFLEXES
Lower limbs and upper limbs
Asymmetry of findings
PRIMITIVE REFLEXES
Sucking and rooting (birth to 4 months when awake, and until 6 months when sleeping)
Palmar grasp (birth until 3 months)
Placing and stepping (from birth until 6 weeks)
Moro (birth to 4 months)
Active tonic neck reflex (ATNR)-turn childs head to one side, a fencing posture develops with the ipsilateral extension of upper and
lower limb (persistence beyond 6 months is abnormal as well as if child cannot break from that position)
NB *for the primitive reflexes listed above persistence beyond the usual time is pathological

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Respiratory Examination A suggested approach

GENERAL INSPECTION
Well or unwell
Cyanosis
Supplemental oxygen
Respiratory rate
Respiratory noises - stridor, wheeze, cough
Respiratory distress - tracheal tug, sternal recession, substernal or supraclavicular retraction
Chest deformity - (barrel chest, Harrisons sulcus, pectus excavatum or carinatum, rib flaring, scoliosis, kyphosis), scars,
symmetry
Growth parameters
Nutrition
Dysmorphic features
Developmental observations
Other- tubes and lines, evidence of steroid excess (e.g., Cushingoid features)
UPPER LIMBS
Nails - clubbing
Palms - anaemia
Wrists - hypertrophic pulmonary osteoarthropathy (HPOA)
Pulses
Blood pressure - pulsus paradoxus
HEAD
Reinspect for anything missed on general inspection
Conjunctivae - pallor
Lips and tongue cyanosis
EAR NOSE AND THROAT

Ears - otitis media (acute or chronic serous)
Nose - polyps (cystic fibrosis)
Mouth - cleft palate
Throat - tonsillitis, airway obstruction
Lymph nodes - anterior, posterior neck and axillary
CHEST
Reinspect - for anything missed on general inspection
Palpation - apex beat, parasternal heave, chest expansion (unreliable in infants), trachea midline
Percussion
- anterior
- posterior
- lateral chest walls
- compare left and right sides
Auscultation - all areas of the chest and comment on-
- air entry
- breath sounds
- crackles
- bronchial breathing
- wheeze
- adventitious sounds
Abdomen
- liver - ptosis (hyperinflated chest), enlarged (right heart failure)
- spleen - portal hypertension in cystic fibrosis
OTHER
Temperature chart, peak flow readings, CXR, ECG

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Gastrointestinal Examination A Suggested approach
GENERAL INSPECTION
Well or unwell? In particular, note whether there is jaundice or pallor
Growth: check weight and height (percentiles)
Nutritional status muscle bulk, subcutaneous fat, peripheral oedema, signs of vitamin A, E, K and D deficiency
Dysmorphic features (in particular Alagille syndrome, or features similar to Cushings disease from steroid excess)
Abdominal scars, stoma, gastrostomy
Bruising (clotting problems), skin rashes (erythema multiforme, erythema nodosum, pyoderma gangrenosum)
UPPER LIMBS
Clubbing (Crohns, coeliac and liver disease etc.)
Leuconychia
Palmar erythema
Palmar crease pallor
Spider naevi
Scratch marks
Rickets; bony changes
Xanthomata
HEAD AND NECK

Eyes Conjunctivae icteric or pale
Iritis (Crohns and Ulcerative colitis)
Mouth ulcers, swollen gums (Crohns), dentition
ABDOMEN
Inspection - Prominent veins
- Distension
- Scars
- Hernias / genitalia
- Perianal fissures, skin tags, haemorrhoids
(NB not appropriate in all situations to proceed with actual examination of the genitalia and the
perianal area, but need to remember and mention importance of these in the gastrointestinal
examination)
Palpation - Liver texture - ?smooth, soft, firm, hard
- Liver size
- Splenomegaly (portal hypertension)
- Enlarged kidneys (polycystic)
- Hernias
- Nodes
- Masses
Percussion - Ascites
LOWER LIMBS
Oedema
Erythema nodosum and other rashes
OTHER
Urine - ?dark
Stools - ? pale, blood, fat or reducing sugars present
Temperature chart

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Cardiovascular Examination A suggested approach
GENERAL INSPECTION
Well or unwell
Growth parameters
Nutrition
Dysmorphic features
Scars
Chest asymmetry
Respiratory rate
Other- note lines or tubes, oxygen saturation readings etc
UPPER LIMBS
Nails
Clubbing
Pulses (including radiofemoral delay)
Blood pressure
HEAD AND NECK

Jugular venous pressure (this is not reliable in young children)
Eyes - conjunctival pallor
Lips and tongue - cyanosis
Mouth check dentition
CHEST
Inspect front, back and axillae for scars, symmetry, apical impulse position
Palpate
Apex position (countdown ribs), beware dextrocardia
Heaves - parasternal, apical
Thrills - suprasternal, supraclavicular
Pulmonary valve closure (pulmonary hypertension)
Auscultate -
Use diaphragm initially then bell
All areas - apex, parasternal border, pulmonary, aortic
Heart sounds (intensity)
Murmurs (systolic, diastolic, continuous, grade and character)
Radiation of murmurs - axilla (mitral), neck (aortic), back (pulmonary, coarctation)
Lung fields - adventitious sounds
Sacral oedema (RVF)
ABDOMEN
Liver edge and span (enlarged-RVH)
Spleen (enlarged-SBE)
LOWER LIMBS
Ankle oedema
OTHER
Urinalysis
Temperature chart
CXR
ECG

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Resource 7: Surgical Component of Child & Adolescent Health Specialty
Block
Welcome to paediatric surgery, the only branch of surgery defined by the age of the patient rather than by a tissue, organ or
system. It is an ancient craft: male circumcision in boys was the first surgical procedure described in the Bible (Genesis 17:10-14)
and had also been performed on Egyptian mummies dating from 2300 BC. As a modern surgical speciality, paediatric surgery
really developed in the 1960s, with advances in anaesthesia, nursing and general medical care of children. It encompasses the
entirety of surgical care in children.
Surgical disease in children is common and accounts for approximately a third of all children presenting to their local doctor or an
emergency department with a medical problem. Tragically, the most common cause of death in Australian children remains
trauma, a surgical disease. Between 1999 and 2000, over twice as many children died as a result of injuries as did those from
malignancy, and seven times as many as those from respiratory illnesses.
Paediatric surgery is a major component of the eight week Child and Adolescent Health Block. As surgical conditions account for
about a third of all childhood diseases, you will be expected to spend about a third of your time, or two to three weeks, learning
about paediatric surgery.
For those students especially interested in surgery, there is the option if undertaking a Pre-internship at the end of the year.
Although there are limited places, a position can usually be arranged either solely in surgery or as part of a combined block with a
medical team. Students may also wish to undertake special study of a paediatric surgical problem and submit this for consideration
for the Douglas Cohen Prize in Paediatric Surgery. Further details on this award are available from the University web site
(http://www.medfac.usyd.edu.au/scholawards/index.php).
Student Learning Outcomes:

At the completion of the CAH block, students will be able to:
1. Take a concise history and perform of focused clinical examination in a child with a surgical disease
2. Formulate a differential diagnosis and decide upon specialist referral or further investigations within an appropriate time
frame
3. Have an understanding of the common surgical conditions in childhood, how they may present and be safely managed
4. Appreciate the importance of appropriate management of resuscitation and fluid balance in children with surgical disease
5. To perform a critical evaluation of the literature and understand the need to apply the principles of evidence based medicine
to children with surgical disease in the context of constantly changing medical knowledge
Useful Web Links:

1. The Royal Australasian College of Surgeons www.surgeons.org
Paediatric surgery update home page for surgeons, residents, medical students, nurses and health-related professionals
dealing with current issues and reviews in the practice of paediatric surgery http://home.coqui.net/titolugo/
The world of paediatric surgery. Interactive site dedicated to clinics and research in the field of paediatric surgery,
specialising in paediatric laparoscopic surgery www.pediatricsurgery.net/

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Resource 8: Surgical Tutorials
A surgical tutor will be assigned to you for the CAH block. Tutors are usually consultant paediatric surgeons, surgical fellows or
registrars training in paediatric surgery. Surgical tutors will conduct four (4) tutorials to cover the core course material. These
tutorials can be scheduled in any of the first seven weeks of the block. Due to other commitments, especially clinical duties, the
tutorials may not be evenly spaced throughout the block. For example, two tutorials may be covered on the same day. The format
adopted for the tutorials will vary between groups and will be discussed with you at your first session.
Tutorial Arrangements:
Timeslot for Week 1 for each group will be pre-arranged with tutors. Tutors will then arrange further meeting times with their own
student group.
Students are allocated to groups by CHW clinical school
Surgical consultants and their Fellows or team Registrars may share the tutorials.
Where appropriate, the tutor may take group to the wards to see patients.
Where students attend Nepean or Northern & peripheral placements in weeks 2-4, please ensure you contact your tutor in week 4
before returning to CHW to confirm tutorial times.
Core Tutorial Content:

1. Abdominal pain and rectal bleeding
Diagnoses of abdominal pain in childhood: appendicitis and differentials; intussusception; Meckels diverticulitis
2. Inguino-scrotal disorders and external genitalia
Including inguinal herniae, hydrocele, umbilical hernia, circumcision, penile disorders, undescended testis, hypospadias, torsion of
testis, fused labia, ambiguous genitalia
3. Bilious and non-bilious vomiting
Pyloric stenosis, malrotation, intestinal atresia, Hirschsprungs Disease and ano-rectal malformations.
4. Common surgical disorders of the head and neck
Swellings in the neck: congenital, acute and chronic neck lumps; recognition and examination.
General principles to be covered throughout the 4 tutorials include fluid resuscitation, recognition of the seriously ill child and when
to refer to a paediatric surgeon.

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Resource 9: Personal & Professional Development Theme Objectives
Sydney Medical School has integrated the Sydney University Graduate Attributes with previous objectives for the Personal and
Professional Development (PPD) Theme to develop a Statement of Expectations (SOE), which outlines the attributes and conduct
expected of medical students. The Coordinator of the Child and Adolescent Specialty Block will use the SOE as a guide to the
PPD goals for the Block. Details of specific student actions required to meet these expectations are provided at:
http://sydney.edu.au/medicine/future-students/pdfs/expectations-statement.pdf

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Resource 10: Guidelines for Structured Paediatric Written History
Patient & Doctor Theme Formative Assessment
The aim of this task is for you to gain experience in the process of taking a paediatric history and documenting it. This task will
help prepare you for the Week 8 Summative assessment.
Prior to writing your history it is recommended that you:
Review the paediatric approach to history taking in Resource 6 of this handbook.

Critically examine a number of patient records.
Review the marking sheet for the structure and marking criteria for this task.
Read through the example of a structured written history which has been provided.
What this task involves

You are required to:
Take and record a structured paediatric history for a patient and family you encounter during Weeks 1, 2, 3 or 4.
Write the history in your own handwriting using progress notes (available from the ward or Clinical School
Write as you would in a patient record, clearly and legibly on hospital record sheets using (progress notes).
Do NOT include the patients name.
Only write the information which is given verbally at the bedside.
Do NOT copy information from the notes to fill in any gaps.
Use common unambiguous abbreviations only [As a guide, you may want to view The Childrens Hospital at Westmeads
Approved Abbreviation List for use in Medical Records
http://chw.schn.health.nsw.gov.au/o/documents/policies/policies/2011-8061.pdf NB: This resource is accessible only from
the CHW Intranet (CHW medical library)
Use point form rather than complete sentences.
Complete only the history (not the physical examination or management)
Use headings as you would in a patient record, commencing with Presenting Symptom (PS) or History of the Presenting
Illness (HPI).
Submit a maximum length of three A4 pages. (If your history is only < 2 pages review it to ensure you have covered all
items before submitting).
Sign your work.
Do NOT copy the history from one that someone else has taken.
Submission and Feedback

The task is due at 8.00am on Monday of Week 5.
Complete the marking sheet available on the CAH website (on left hand menu, select Self-Directed Learning and then
click on Assessment Resources and Sample Tests.)
This includes adding your name and Clinical School to the marking sheet and completing and signing the plagiarism
statement.
Attach both completed forms to your history.
Your history will be reviewed by a medical bedside tutor other than your own. It will be available with comments for
collection from CHW Clinical School
SRH Students: SRH students: Submit to Student Administration at CHW or the coordinator in Dubbo or Orange by Monday of
Week 5.
If you have any concerns about feedback regarding your history, please contact Student Administration at CHW or your
coordinator in Dubbo or Orange to arrange for further discussion with the marker.

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Block - Child and Adolescent Health - Handbook

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Specialty Block Handbook

2016 Sydney Medical School, University of Sydney

Child and Adolescent Health Specialty Block............................................ 3

Resources Section ................................................................................. 11

Child and Adolescent Health 2016 Sydney Medical School

Sydney Medical School Stage 3 Attendance Policy

Child and Adolescent Health 2016 Sydney Medical School

Child and Adolescent Health 2016 Sydney Medical School

The CAH Specialty Block at a Glance

Structured Teaching Program

Clinical Reasoning Sessions (CRS)

Child and Adolescent Health 2016 Sydney Medical School

Evidence Based Medicine in the Clinical Reasoning Process

What students need to do for the EBM Task

Roles & Responsibilities in Clinical Reasoning Sessions

Child and Adolescent Health 2016 Sydney Medical School

Step 1: Case Allocation

Step 2: Review/Work through web-based clinical reasoning case

Step 3: Prepare your clinical reasoning tutorial

Patient history & examination

Develop clinical reasoning guide

Prepare for case facilitation

Step 4: Run your clinical reasoning tutorial

Child and Adolescent Health 2016 Sydney Medical School

Procedural skills and other workshops

Clinical Application Sessions with Experts (CASE)

Small group teaching (see resource section)

We expect students to undertake the following activities:

Child and Adolescent Health 2016 Sydney Medical School

Structured Written History: due on Monday of Week 5

Basic and Clinical Science

Patient and Doctor

Personal and Professional Development

Summative Assessments covering all Themes

Your examiner and time will be allocated to you by the

3 OSCE stations (8 minutes each):

Final Paediatric mark

CAH Block mark 70% As above

Child and Adolescent Health 2016 Sydney Medical School

Reassessment for in-block summative assessment (i.e., further assessment)

Personal and Professional Development (PPD)

Child and Adolescent Health 2016 Sydney Medical School

Child and Adolescent Health 2016 Sydney Medical School

Competency & Specific Skills Assessment Learning mode

Child and Adolescent Health 2016 Sydney Medical School

Competency & Specific Skills Assessment Learning mode

Child and Adolescent Health 2016 Sydney Medical School

Application and care of plasters Formative: supervisor feedback Clinical attachments

Child and Adolescent Health 2016 Sydney Medical School

GENERAL CHILD & ADOLESCENT TOPICS

Evidence Based Medicine:

Normal development and developmental problems:

Growth and nutrition:

Common acute presentations: recognising and managing the sick child

Children and adolescents at risk:

Infectious diseases in childhood from a global and regional perspective:

Child and Adolescent Health 2016 Sydney Medical School

Immunological problems in childhood:

Acute sepsis in children:

The dysmorphic child:

Common early dental problems:

Paediatric dermatology - common presentations:

Common eye problems in childhood:

Common ENT problems: