Hospital Paediatrics with Outpatient Consultations incl. Ambulatory Paediatrics

1.During the study course a resident acquires and strengthens knowledge on the sections of the residency program, by acquiring defined competence pursuant to three levels. The knowledge will allow: • to characterise epidemiology of health and illnesses of children; • to understand somatic, social - psychological and intellectual development of children, as well as aetiology, pathogenesis, pathophysiology, symptomatology of congenital and acquired disorders and diseases; • to take decisions regarding diagnostics, differential diagnostics, therapy and prevention of paediatric health disorders and illnesses, rehabilitation, nutrition; • to understand basis of subspecialties, as well as possibilities of other specialties related to paediatrics or to acquire the 1st year study programme of the subspecialty. During the rotation discipline a resident acquires basic knowledge and competence on assessment of the condition of acutely ill children, provision of first aid in various emergency situations, use of diagnostic and treatment algorithms, principles of early therapy in cases of acute illness and emergency situations. To analyse the ultrasonographic deposit of superficially placed tissues and organs, the results of ultrasonographic examination - to be able to evaluate the ultrasonographic dynamics of pathological conditions: • physical bases of ultrasonography, technique, basic principles of image interpretation; • principles of USG examination of liver, biliary tract, pancreas; • principles of USG spleen examination; • principles of USG investigation of acute abdominal diseases and traumatic injuries; • principles of chest wall, pleural space, and soft tissue USG examination.

1.A resident will acquire the following skills: • to provide qualified medical aid to children in acute and chronic cases, perform diagnostics, treatment, rehabilitation and preventive care pursuant to the primary and secondary healthcare level, as well as to promote children’s health, harmonious development and protection of their interests; • within the framework of his/her specialty, to advise patients, their relatives and other medical practitioners’ • to actively participate in studies on prevention of childhood illnesses, disease prevention, public health, education of uncertified medical practitioners and medicine students, as well as studies related to children’s health; • to be responsive in establishing professional relations with patients and their caretakers, colleagues, having due regard to cultural and ethnical peculiarities, national and global children’s rights, principles of ethics, professional secrets and confidentiality; • to avoid unnecessary examinations, unjustified treatment and unnecessary hospitalisation of a child; • to work in team, to collaborate with parents and other groups of society. Upon acquisition of the rotation discipline a resident will be able to carry out examination and evaluation of a child’s objective clinical condition and vital indications based upon the age of the child, to gather a history of illnesses, to draw up examination plan, to order additional examination methods and to evaluate the results, to carry out cardiopulmonary reanimation, to carry out peripheral venous catheterisation, to commence therapy of various childhood diseases, to modify the therapy pursuant to the dynamics of the patient’s condition during the first 24 – 48 hours. To perform ultrasonographic diagnostics in patients with acute, urgent diseases and pathological conditions of various organ systems.

1.The competences given below are important but not comprehensive (the scope of competences can be extended should there be preconditions for that during the studies), they should be acquired in relation to a patient of the respective speciality, his/her parents, activities of the health care specialists, and type of healthcare organisation:  To consult patients and their families • to gather anamnesis; • to carry out physical examination based upon the patient’s age; • to assess growth and development; • to perform dietary assessment; • to evaluate psychological condition; • to carry out clinical evaluation and make decisions; • to provide explanations and consultations; • to encourage and provide professional support.  To evaluate clinical exposure, order examination, set diagnosis and agree on a treatment plan • to recognise and evaluate severity of clinical exposure; • to create differential diagnosis; • to consider child protection issues; • to order necessary examination and to interpret the results; • to consult with multidisciplinary specialists; • to agree on an appropriate health management plan with patients and their caretakers.  To provide immediate healthcare to children in emergency situations, including first aid and resuscitation • to recognise and evaluate acute paediatric emergency problems; • to provide basic first aid; • to provide paediatric emergency care; • to provide cardiopulmonary resuscitation to neonatal and paediatric patients pursuant to the European guidelines currently in effect; • to provide basic information in case of injury pursuant to the European guidelines currently in effect.  To prescribe nutrition, medicinal products, liquid preparations and blood products • to clearly and precisely prescribe nutrition, medicinal products, liquid preparations and blood products • to coordinate nutrition, medicinal products, liquid preparations and blood products in clinical context • to reconsider adequacy of treatment and to evaluate possible gains and risks; • to treat pain and suffering.  To carry out practical activities A paediatrician is competent in performing various practical manipulations (see the list of manipulations) applied to infants, children and teenagers. In relation to any of these manipulations the resident shall prove his/her ability: • to provide respective information to the child and parents; • receive informed consent, when necessary; • to apply minimum possible invasive procedures; • to reduce pain and suffering; • to use appropriate hygiene and infection prevention activities; • to make respective records on manipulations in the medical documentation.  Ensure effective communication within the context of paediatrics • to communicate with infants, children and teenagers; • to communicate with caretakers and relatives; • to communicate with other multidisciplinary specialists; • to ensure continuity of healthcare; • to stop or reduce bad news, to skilfully explain such news; • to communicate with disabled children and teenagers; • to communicate with people requiring interpreter’s assistance; • to seek and receive informed consent, where necessary; • to communicate in written form, including medical records, phone and other means of communication; • to act adequately in cases of aggressive behaviour.  To apply ethical and legal principles in paediatric care • to apply ethical principles and analysis in clinical health care and research; • to apply national and EU laws and regulations in clinical healthcare and research; • to protect children’s rights pursuant to the United Nations Convention on the Rights of the Child and the laws of Latvia • to maintain confidentiality; • to evaluate patient’s ability to give consent; • to obtain and record patient’s informed consent; • to provide information regarding organ donation; • to confirm a death; • to write a request for autopsy.  To assess psychological and social aspects of a patient’s illness • to evaluate the impact of psychological factors on expressions of illness and the illness itself; • to evaluate the impact of social factors on expressions of illness and the illness itself; • to evaluate the impact of patient’s condition on education and school; • to determine stress caused by illness to children, their families and caretakers; • to detect alcohol and drugs abuse and dependence; • to collaborate with respective colleagues in due time.  To apply evidence-based medical knowledge, principles, skills • to use evidence in practice; •to identify and perform search of respective literature; • to undergo a critical review of published medical literature.  To efficiently use information and information technologies within context of paediatrics • to complete clinical records in precise and complete manner and due time; • to be able to access international scientific information on paediatrics; • to save and obtain information.  To be able to apply scientific principles, methods and knowledge in practice and studies related to children • to apply scientific principles in paediatric practice; • to analyse and distribute research results; • to prove comprehension of research design and methodology, including statistical analysis.  To facilitate individual and public health and to effectively operate within the healthcare system • to comply with the national screening, monitoring and immunisation programs; • to apply measures to prevent spread of an infection; • undergo dietary assessment and provide useful advice and support on healthy nutrition, including ability to manage obesity and undernourishment cases; • to study the risks of illnesses and harm to children and manage them accordingly; • to promote safety of patients and prevention of accidents; • to ensure compliance with the professional certification; • to prove comprehension of the structure, organisation and operation of the healthcare system  To perform one’s duties in professional manner Professional qualities: • honesty, decency and commitment to ethical practice; • commitment to maintain good practice and quality; • criticism and self-criticism, reflective practice; • empathy; • initiative; • interpersonal communication skills. Professional work: • to acknowledge the limits of one’s possibilities and to ask for help; • to work autonomously, when necessary; • to solve problems; • to pass decisions; • to work in multidisciplinary groups; • to contact experts, who do not represent disciplines of medicine; • to demonstrate leadership skills; • to be able to adjust to new situations and work in changing circumstances; • to be able to organise and plan, as well as to understand time management; • to make wilful career choice, including specialisation in sectors of paediatrics.  To carry out functions of a paediatrician-expert • to be able to analyse and synthesise; • to be able to study (including life-long self-education) and to apply the knowledge in practice; • to demonstrate teaching skills; • to apply research skills.  To carry out paediatrician’s functions in a global context • to understand diversity and multiculturalism; • to understand various cultures and traditions of migrants; • to demonstrate proficiency in local language and culture; • to be able to work in an international environment; • to have responsive attitude towards environment and use of natural resources. The necessary level of competence varies for various cases of paediatric emergency and is provided in the table below. The competence levels are the following: 1st level: acquired knowledge complies with general concept of the subject matter, allowing the practitioner to understand the situation by reading literature or when coming across in practice, by engaging in purposeful search for necessary additional information and referring the patient to a specialist, when necessary. 2nd level: acquired knowledge on the particular matter is sufficient for understanding its nature, to diagnose the problem and provide emergency aid, when necessary, refer to a specialist, as well as to carry out diagnostics, treatment and prevention under the supervision of a specialist. 3rd level: acquired knowledge allows the practitioner to solve the particular problem independently. 1.General principles 3 Body fluid pathophysiology and fluid therapy 3 Water and sodium balance disorders in cases of various acute illnesses 3 Acid-base balance disorders in cases of various acute illnesses 3 Fluid and electrolytes, therapy of specific illnesses 3 Acutely ill child Assessment of an acutely ill child in the hospital 3 2. Provision of emergency care in cases of various illnesses and conditions 3 Emergency conditions in paediatrics Coma in children 2 Resuscitation 3 Shock 3 Drowning 2 3. Principles of drug therapy in children 3 4. Seizures in children 5. Acute diarrhea 3 6. Pylorus stenosis 2 7. Starvation 2 8. Harmful effect of the environment on health Effect of mercury and intoxication 1 Lead-poisoning 1 9. Intoxication with chemicals and medicaments, principles of action 3 Acetaminophen 2 Salycilates 2 Hydrocarbon 2 Iron preparations 2 Cyclic antidepressants 2 Acids and bases 2 Nonsteroidal anti-inflammatory drugs 2 Plants 2 Non-bacterial food poisoning 2 10. Intoxication after contact with animals 2 11. Electrical injury 2 12. Adrenal gland insufficiency 13.Able to independently perform ultrasonography of the abdominal cavity, superficial tissues and organs and interpret the results.