|Title||Paediatric Practice in Gastrointestinal and Urodynamic Sciences|
Children are a complex patient group who require special management, but who form a significant part of the caseload in both specialities. By the end of this module the Clinical Scientist in HSST will gain paediatric knowledge including the initial clinical assessment of the child presenting with symptoms and signs suggesting a gastrointestinal or urodynamic disorder. They will be expected to appreciate the limitations of appropriate physiological measurements on children with particular emphasis on the effects of ionising radiation. They will recognise, deliver and report the appropriate physiological test to address the findings from initial clinical assessment and critically apply their knowledge of management options available during discussions with the supervising clinician based on investigation findings. They will critically evaluate their own response to both normal and complex situations using the professional attributes and insights required of a Consultant Clinical Scientist. Particular emphasis will be placed on how the child perceives the investigation, preservation of dignity and safety e.g. effects of ionising radiation.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will be able to critically analyse, synthesise and apply their knowledge with respect to paediatric investigations including:
- child safeguarding.
- the embryology of the GI and uro-genital tracts with specific reference to urethral and genital abnormalities.
- differences between the relevant adult and paediatric anatomy and physiology.
- common paediatric disorders, for GI: imperforate anus; Hirschspring’s disease; hiatus hernia; oesophageal atresia; gastroeoesophageal reflux; lactose malabsorption; gastropariesis; oesophageal, gastric, small and large bowel and anorectal dysfunction.
- the physiological investigations appropriate for assessing the disorders given above. This should include for GI: manometry; Breath tests; pH and impedance; ultrasound; gastric emptying; endoscopy; barium studies.
- for urodynamics: renography and micturating cystography.
- limitations and modifications necessary for these routine investigations in children, including the way in which the immature physiology can affect the interpretation of paediatric studies.
- possible management options for common paediatric disorders. This should include for GI disorders: Antireflux procedure; sacral nerve stimulation; pull through procedure; stoma; ACE and MACE button.the common paediatric urological diseases, including as a minimum: nocturnal enuresis and elimination disorders; cryptorchidism; vesico-ureteric reflux; childhood urinary tract infection; eosinophilic oeosphagitis.
- for urological disorders: intra-vesical botulinum toxin treatment; augmentation cystoplasty; artificial urinary sphincter insertion; urinary diversion; urinary catheterisation including intermittent self-catheterisation.
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills appropriate to delivery of the physiological investigations above, including the following technical skills:
- aseptic technique.
- test preparation.
- intubation or otherwise preparation of children for appropriate GI or urodynamic studies.
- performance of each investigation.
- cleaning, disinfection and sterilisation.
- accurate and succinct reporting of the data acquired.
- quality control/quality assurance.
By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians and other healthcare professionals. They will demonstrate a critical understanding of current relevant research, theory and knowledge and its application to the performance of clinical skills, applying rigorous scientific critiques to the evaluation of data related to clinical practice in the support of clinical decision making and patient management and critically reflect on their performance and be able to:
- recognise the particular difficulties conducting urodynamic investigations in children placing particular emphasis on considering the appropriateness of the investigation, given the age of the patient and the likely benefits of the investigation.
- take appropriate clinical history and critically assess the clinical question.
- make appropriate decisions about specialist investigation, where necessary adapting the appropriate diagnostic test for the patient.
- explain and justify the rationale for the investigation, its risks and benefits to the patient or guardian, using age-appropriate language or communication.
- obtain written informed consent or assent.
- interpret clinical data to produce diagnostic quality clinical reports.
Attitudes and behaviours
By the end of the module the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations consistently demonstrating the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence. The Clinical Scientist in HSST will recognise the special issues in relation to consent, legal and regulatory issues and (for young children) inability to communicate. They will:
- maintain highest standards of professional behaviour including a prioritisation of patient’s dignity during intimate examinations.
- work within personal limitations and know when to ask for help, especially with regard to clinical issues.
- use effective judgement and decision-making skills.
- work effectively in a multi-disciplinary team and demonstrate leadership where appropriate.
- refer as appropriate to senior staff.
- manage time and prioritise workload e.g. balance urgent and important demands.
- apply ethical principles, safety, confidentiality and consent.