Standards for Speciality Training in Paediatrics

Paediatric Guidance Checklist These standards were derived to assist in the assessment of the paediatric training standards of in your deanery

Specialty: Paediatric Immunology, Infectious Diseases and Allergy

The Programme (which may consist of several posts) should provide: 1. Supervision - For both allergy and immunology/infectious / diseases 1.1 An educational supervisor who is a Consultant paediatric allergist or Consultant in paediatric infectious diseases/immunology trained in assessment and appraisal 1.2 An educational supervisor who provides average 4 hours (1PA) per week of educational supervision 1.3 Evidence that the assessment strategy is being delivered 1.4 Trainers receive appropriate training on the delivery of the assessment strategy 1.5 appropriate supervision to ensure patient safety

2. Other Personnel For both allergy and immunology/infectious diseases 2.1 A minimum of 2 consultants in specialty to support & supervise 2.2 More than one ST4 -8 in the children’s department For allergy only 2.3 at least one paediatric dietician experienced in paediatric allergy 2.4 at least one paediatric allergy clinical nurse specialist trained in allergy skin testing and administration of specific immunotherapy For immunology/infectious diseases only 2.5 clinical nurse specialists in HIV + TB +/- others e.g. hepatitis 2.6 clinical nurse specialists in immunology involved in the delivery of immunoglobulin therapy.

3. Service requirements and facilities - For both allergy and immunology/infectious diseases Allergy only 3.1 Specialty specific requirements of subspecialty department: Full complement of doctors specialist nurses and paediatric dieticians Full range of allergy diagnostic testing Day ward facility for drug and food challenges Established immunotherapy service 3.2 Specialty specific requirements of service departments relevant to delivery of curriculum PICU, outpatients clinic in dermatology, paediatric respiratory medicine, paediatric gastroenterology, feeding clinics and paediatric ENT 3.3 Specialty specific requirements of related clinical departments that are involved in delivery of the curriculum: Access to immunology diagnostic laboratory, a pulmonary function measurement laboratory, paediatric dietetic and psychiatry departments 3.4 Specialty specific requirements of clinical networks: Established networks with an adult allergy department, clinical immunology and links with community paediatrics Immunology and Infectious Diseases

Paediatric Guidance Checklist Immunology, Infectious Diseases and Allergy 1 3.5 Specialty specific requirements of subspecialty department: Multi-disciplinary support to inpatient management

3.6 Specialty specific requirements of service departments relevant to delivery of curriculum PICU, bone marrow transplantation, extensive range of sub-specialties e.g. orthopaedics, neurosurgery 3.7 Specialty specific requirements of related clinical departments that are involved in delivery of the curriculum: Microbiology, virology, immunology laboratories, pulmonary function testing, dietetics, comprehensive radiology 3.8 Specialty specific requirements of clinical networks: HIV, TB, General Paediatric Infectious Diseases, adult HIV/TB, community paediatrics (immunisation), immunoglobulin therapy

4. Educational activities and training Allergy Only 4.1 Specialty specific clinical exposure required to provide sufficient learning opportunities(NB if giving workload data ensure it is explicit whether this is number per annum or number trainee would be expected to be exposed to over entire programme): Regular opportunities to participate in the inpatient care of children following sever allergic reactions Supervise children attending for food and drug challenges – 40 per year Develop appropriate protocols and drug desensitisation Supervise the administration of immunotherapy – 70 procedures per year Opportunity to liaise with community paediatricians, school and community nurses 4.2 Specialty specific requirements for structured training opportunities to include courses: Attend the allergy and immunology modules of BPAIIG training programme The allergy training workshop held by BASCI Attend a basic immunology course or equivalent Member of the British Society for Allergy and Clinical Immunology Encouraged to be a member of the European Academy of Allergy and Clinical Immunology 4.3 Specialty specific requirements for other experiential learning(excluding clinics and ward rounds): Facilitate an understanding of the role of voluntary organisations and support groups Immunology and Infectious Diseases 4.1 Specialty specific clinical exposure required to provide sufficient learning opportunities (NB if giving workload data ensure it is explicit whether this is number per annum or number trainee would be expected to be exposed to over entire programme): Exposure to severe (transplantable) immunodeficiencies 4.2 Specialty specific requirements for structured training opportunities to include courses: 75% minimum attendance at: Infection and Immunity course, PENTA/ESPID HIV course, ESPID case rounds, BPAIIG modular training days, basic immunology course 4.3 Specialty specific requirements for other experiential learning(excluding clinics and ward rounds): Microbiology, virology, immunology laboratory attachments, understanding of voluntary organisations and support groups

Paediatric Guidance Checklist Immunology, Infectious Diseases and Allergy 2 5. Working patterns - For both allergy and immunology/infectious diseases 5.1 Safe cover arrangements for paediatric department out of hours in line with RCPCH guidance 5.2 Evidence of compliance with existing employment working time 5.3 Working intensity and pattern that is appropriate for learning 5.4 It is unlikely that sufficient access to the sub-specialty will be given if more than 1/3 of hours are spent outside specialty 5.5 the post forms part of a complete paediatric training programme which provides a minimum of 5 years acute clinical experience, including out of hours duties

6. Specific Post requirements 6.1 Allergy only For Specialty Training – minimum of 24 months clinical training to include. In a 3 year programme a further 12 months maybe clinical or research in appropriate settings 6.2 Immunology/Infectious Diseases only For Specialty Training - minimum of 24 months clinical training to include 6 months gastroenterology. In a 3 year programme a further 12 months maybe clinical or research in appropriate settings 6.3 Immunology emphasis Within a 24 month programme a minimum of two months in a Paediatric BMT unit, minimum of two months attached to Adult immunology

7. Enabled to learn new skills, necessary skills and curriculum coverage (speciality specific) 7.1 Allergy - Specialty specific marker conditions trainee should be exposed to: Food allergy (IgE and non-IgE mediated) Eczema Urticaria / angioedema Asthma / recurrent wheeze Rhinoconjunctivitis Allergic rhinitis requiring treatment with immunotherapy (minimum 5 cases per year) Venom allergy Drug allergy Vaccine reactions Latex allergy Idiopathic anaphylaxis Exercise induced anaphylaxis Oral allergy syndrome Vocal cord dysfunction 7.2 Specialty specific skills/procedures trainee needs to complete: skin prick testing, intradermal testing, atopy patch testing, administration of subcutaneous and sublingual immunotherapy, pulmonary function measurement, interpretation of levels of specific IgE, food and drug challenge 7.3 Immunology/Infectious Diseases - Specialty specific marker conditions trainee should be exposed to: Common infectious diseases in different age groups. Unusual infections including tropical diseases, opportunistic infections, infection in immunocompromised host. HIV Paediatric Guidance Checklist Immunology, Infectious Diseases and Allergy 3 TB Hepatitis Organ specific infections, e.g. osteomyelitis, cerebral TB etc. Primary Immunodeficiencies including minor, moderate (requiring immunoglobulin replacement) and severe (requiring bone marrow transplantation or gene therapy). Secondary immunodeficiencies complicated by infections.

For those training with emphasis on immunology: autoimmune and immunodysregulatory disorders Hereditary angio oedema common allergic disorders, 7.4 Specialty specific skills/procedures trainee needs to complete: Tuberculin skin test, skin biopsy, bone marrow aspiration

8. Access to clinics and ward rounds & long term care of patients 8.1 Allergy - Specialty specific numbers and types of clinics expected to attend:: At least 2 supervised allergy clinics per week (80 per annum) Attendance at 20 gastroenterology clinics 20 respiratory clinics 10 paediatric dermatology clinics 10 adult allergy clinics 10 paediatric ENT clinics 8 paediatric immunology clinics 8.2 Specialty specific combined clinics trainee is expected to attend:

8.3 Specialty specific ward rounds

8.4 Specialty specific involvement in transitional care - gastroenterology: Involvement in the transition of care to an adult allergy service 8.5 Immunology and Infectious Diseases - Specialty specific numbers and types of clinics expected to attend including outreach clinics: At least 1 supervised clinic per week during 2 year programme to cover exposure to HIV, TB, general infectious diseases and immunology 8.6 Specialty specific combined clinics trainee is expected to attend: Mother and child HIV clinic 8.7 Specialty specific ward rounds: Minimum of 1 ward round per week to include MD/microbiology joint rounds and immunology/BMT rounds 8.8 Specialty specific involvement in transitional care - hepatology: HIV transitional care; transition of long-term immunoglobulin dependent patients 8.9 Inpatient consult service for other sub-specialties to include PICU, NICU and range of organ specific subspecialties

Paediatric Guidance Checklist Immunology, Infectious Diseases and Allergy 4 9. Meetings 9.1 Allergy - Specialty specific number and types of MDT meetings expected to be exposed to: Weekly team meetings 9.2 Specialty specific multi-professional meetings trainee is expected to be exposed to: Opportunities to meet with community paediatrics and dietetics Member of an appropriate regional paediatric allergy group 9.3 Speciality specific other meetings: Academic meetings/journal clubs 9.4 Immunology/Infectious Diseases - Specialty specific number and types of MDT meetings expected to be exposed to: Weekly HIV MDT Monthly TB 9.5 Specialty specific multi-professional meetings trainee is expected to be exposed to:

9.6 Speciality specific other meetings: Academic meetings/journal clubs

10. Clinical audit For both allergy and immunology/infectious diseases 10.1 Evidence of trainees participation in clinical governance (at least 1 full audit/year and attendance at critical incident meetings) 10.2 Evidence of trainees participation in clinical guideline development 10.3 Specialty specific audit requirements e.g. participation in national CHIPS (HIV) audit or allergy audit

11. Teaching appraising and assessing For both allergy and immunology/infectious diseases 11.1 Opportunities for formal and informal teaching 11.2 For senior trainees: opportunities for involvement of assessment of others 11.3 For senior trainees: opportunity to be involved in the appraisal of others

12. Research For both allergy and immunology/infectious diseases 12.1 Provide formal teaching on research ethics and research methodology 12.2 Provide opportunities to be involved in clinical research 12.3 access to laboratory based research facility 12.4 Completion of higher degree and/or publication of at least one research paper as first author 12.5 opportunity to present at national/international meetings

13. Management For both allergy and immunology/infectious diseases 13.1 Opportunities to be involved in management e.g. participation in management meetings and projects including attendance at specialty business meetings 13.2 participation in Trainees group, opportunity to stand or vote for trainee’s representative in PGHAN CSAC, BSPGHAN and organise post- Paediatric Guidance Checklist Immunology, Infectious Diseases and Allergy 5 graduate and associate members day at BSPGHAN winter meeting

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