Gastroenterology & Hepatology Curriculum

This version of the curriculum has been modified by the London Specialty School of Paediatrics for use by local trainers. It identifies which competencies will be provided on regional training days, on simulation courses and compulsory training courses as part of the training package. All competencies in black font have been identified as competencies trainees are expected to obtain in their local trusts, by clinical experience or by local teaching programmes.

Red – regional training Blue – simulation Green – external courses Black – local learning

Level of Training Knowledge Skills Generic Level 1 have the knowledge and recognise when to request skills to be able to assess and a specialist opinion initiate management of patients presenting with common gastroenterological problems in acute and outpatient settings

understand the role of interventional procedures eg endoscopy or colonoscopy in the investigation of gastroenterological disorders Level 2 continuing development of level 1 competencies Acute abdominal Level 1 know the causes of acute recognise when to request pain abdominal pain a surgical opinion

recognise conditions which require urgent intervention eg. intussusception Level 2 continuing development of recognise the need to level 1 competencies consider acute appendicitis in very young children

recognise signs of pain in an infant or small child Acute vomiting Level 1 know the causes of the recognise features in the and/or diarrhoea symptoms of acute presentation which suggest diarrhoea and vomiting serious pathology eg haemolytic uraemic syndrome, appendicitis, intestinal obstruction Level 2 understand the scientific be able to implement local principles for oral and isolation policies intravenous fluid therapy Jaundice Level 1 know the causes of neonatal and childhood jaundice Level 2 continuing development of be able to investigate level 1 competencies appropriately and know when to refer to specialist services Upper and Lower Level 1 know the causes of upper be able to assess the GI bleeding and lower gastro-intestinal severity of the condition bleeding be able to institute understand the potentially appropriate emergency life-threatening nature of his treatment presentation Level 2 continuing development of recognise features in the level 1 competencies presentation which suggest serious pathology Abdominal Level 1 know the causes of distension abdominal distension Level 2 continuing development of be able to initiate level 1 competencies investigation and seek surgical opinion when required Acute liver failure Level 1 be familiar with the causes of acute liver failure

know the management of paracetamol poisoning Level 2 know the causes of acute be able to assess the liver failure severity and complications of this condition

be able to initiate appropriate resuscitation and liaise early with the paediatric liver unit Congenital Level 1 know the presenting Be able to institute abnormalities features of congenital appropriate emergency abnormalities including treatment tracheo-oesophageal fistula, malrotation, bowel atresias, Hirschsprungs disease, abdominal wall defects, diaphragmatic hernia

be familiar with potential associated abnormalities

know when ante-natal transfer to a Neonatal Surgical Centre should be considered Level 2 continuing development of be able to assess the fitness level 1 competencies of the baby and the need to transfer to a specialist centre

recognise when the bowel might be compromised

recognise the need to liaise with surgeons and when this is urgent Gastro Level 1 know the range of recognise the range of signs presentations of gastro- and symptoms associated oesophageal oesophageal reflux and with gastro-oesophageal reflux and oesophagitis in otherwise reflux and oesophagitis well infants and children and oesophagitis also in disabled children Level 2 continuing development of manage mild and moderate level 1 competencies gastro-oesophageal reflux and recognise when to refer Chronic or Level 1 know the possible biological, recognise features in the recurrent psychological and social presentation that suggest contributing factors in the importance of different abdominal pain chronic or recurrent aetiologies abdominal pain Level 2 know which features suggest be able to refer that reassurance rather than appropriately to psychology investigation is needed when required

consider when there might be child protection issues Chronic Level 1 know the causes of chronic diarrhoea and/or diarrhoea and/or vomiting vomiting be aware of the characteristics of bulimia Level 2 continuing development of be able to initiate level 1 competencies investigations Constipation with Level 1 be familiar with local and be able to manage simple or without soiling national guidelines for constipation with and management of without soiling constipation, recognise when to liaise know about predisposing with more senior conditions eg paediatricians, specialist hypothyroidism, nurses, psychologists and neurodisability, psychiatrists psychological problems Level 2 understand the relevance of be able to follow local and predisposing conditions eg national guidelines for hypothyroidism, management neurodisability, psychosocial problems Dysphagia Level 1 know the causes of be able to distinguish dysphagia between organic and functional dysphagia Level 2 continuing development of level 1 competencies Malabsorption Level 1 know the causes of recognise the role of the malabsorption including dietician and to liaise coeliac disease and cystic appropriately fibrosis and its consequences

understand the principles of treatment of the different types of malabsorption Level 2 continuing development of be able to explain and level 1 competencies initiate investigations, nutritional assessment, dietary principles and liaise appropriately with dietician Malnutrition Level 1 know the causes of be able to assess nutritional malnutrition including organic and non-organic status causes be able to initiate be familiar with the investigations to establish consequences of the diagnosis and to detect malnutrition nutritional deficiencies

know the principles of enteral and parenteral nutrition support Level 2 continuing development of level 1 competencies Iron deficiency Level 1 know the causes of iron be able to manage iron anaemia deficiency anaemia including deficiency anaemia poor diet, bleeding, malabsorption

understand factors which predispose to dietary iron deficiency anaemia

be aware of the consequences of the condition Level 2 continuing development of be able to counsel parents level 1 competencies about preventing dietary iron deficiency