Patient management

1. Patient management

2. Introduction • Domain 4 – Patient Management is our every day practice • Aims to improve Patient Management by encouraging good practice Resuscitation Management of the dying child Awareness of limitations MDT working Evidence based medicine

3. Curriculum overview

4. Curriculum overview

5. Curriculum overview

6. Underpinning knowledge

7. Everyday Practice Diagnoses and supervises treatment in the common pathologies seen in babies and CYP. Carries out an assessment, makes a differential diagnosis, plans appropriate investigations and initiates a treatment plan in accordance with national and local policies • Performs an assessment of a child’s physical, mental, and developmental status, incorporating biological, physiological and social factors across multiple clinical contexts

8. Resuscitation and the Acutely Unwell Child • Recognises the life-threatening nature of some acute situations in CYP and knows when to call for help or seek personal support. • Advanced Paediatric life support • Neonatal Life support • Mini-cex/ CBD/ reflection after life threating cases • Demonstrates the ability to provide and lead basic and advanced resuscitation, including advanced airway management with the use of airway adjuncts to the point of intubation. • Recognises common presentations which may indicate life-threatening pathology and require urgent action.

9. Care of the Dying Child • Important skill • Only covered in this capability in the generic curriculum • Only one chance to get it right in each case • Other ways to develop the skills • Communication study days • Simulation • Working with a hospice • Seeks specialist advice for palliative care emergencies

10. Evidence Based Medicine Assesses the evidence base for treatment and assessment strategies, their limitations and when to act outside them with senior support. • What? EBM is the conscientious, explicit, judicious and reasonable use of best evidence is making decisions about the care of individual patients • Why? To provide the best care for our patients. e.g. Corticosteriods in labour • How Guidelines Assessing the research • Evidencing Clinical Questions – in ePortfolio Evidence based medicine course Guideline review/development In accordance with national and local policies • Models colleagues a flexible, holistic, reflective, evidence-based approach to practice

11. Multi-Disciplinary Working • Improves Paediatric Care • Improves job satisfaction for the team • But… don’t always work as well as we hope • Wider than your own service • Transition • Evidencing Anticipates the need for transition to another service or is able to work jointly alongside another service to care for a patient Demonstrates expertise in the multi-professional management of a range of common general paediatric conditions, both acute and chronic; adjusts protocol to the particular situations of CYP Works effectively with colleagues in primary care to manage risk in a considered manner Collaborates flexibly across local health systems to lead in care quality

12. Conclusions • Continue your every day practice but review and reflect. • Consider the key capabilities as prompts to help you develop into the best version of your future clinician self

13. Useful training and resources • RCPCH exam skills courses • RCPCH ‘How to manage’ clinical skills courses • RCPCH ‘Progressing paediatrics’ clinical courses • RCPCH e-learning courses • APLS/EPLS/NLS • Child bereavement study days • RCPCH guideline consultation panel