Medical Consultant Training in Paediatric Rehabilitation

Location:
Rehabilitation Department
The Children's Hospital at Westmead
Cnr Hawkesbury Road & Hainsworth Street
Westmead NSW 2145
AUSTRALIA

Mailing Address:
Rehabilitation Department
The Children's Hospital at Westmead
Locked Bag 4001
Westmead NSW 2145
AUSTRALIA

Phone: 61-(0)2-98452819
Fax: 61-(0)2-98450685
Website: http://www.chw.edu.au/rehabilitation

• Past/Present Appointees:
• Paediatric Rehabilitation Trainees (12 month attachments)
• Post graduate Fellow in Paediatric Rehabilitation
• Musculo-Skeletal Fellow
• (Adult) Rehabilitation Medicine Trainee
• Honorary Paediatric Rehabilitation Trainees (Home City/Country)
• Advanced Paediatric Trainees ( 6 month attachments available)
• Botulinum Toxin Training Program - National and International
• Medical Staff
• Clinical/Academic Staff Physicians
• Introduction
• Training Positions
• Job Descriptions:
• A. Paediatric Rehabilitation Trainees
• B. Paediatric Advanced Trainees (6 month position)
• C. Clinical/Postgraduate/Research Fellows
• D. Honorary Fellows
• E. Adult Rehabilitation Fellow
• Working Environment
• Learning Directives for Trainees in Paediatric Rehabilitation Fellowship
• Overall Goal:
• Goal: Become clinically proficient in the acute rehabilitation management of the child with acquired brain injury and (acquired) spinal cord injury & disease
• Goal: Become clinically proficient in the long term rehabilitation management of children with physical disability and acquired cognitive dysfunction.
• Goal: Develop and demonstrate Teaching competence
• Goal: Acquire Knowledge and skills needed to be a productive investigator
• Goal: Exposure to administrative management and issues in a Rehabilitation Unit
• Primary References
• Recommended Reading/Resource Materials
• Journals:
• Organisations/Websites
• Cerebral palsy
• Adult spinal cord injury sites and information sheets
• Epilepsy
• Muscular Dystrophy
• Spinal Bifida

Past/Present Appointees:

Paediatric Rehabilitation Trainees (12 month attachments)

1991/92/93	Dr Peter Hong	FRACP FAFRM
1993/94	Dr Kevin Lowe	FRACP FAFRM
1994/95	Dr Catherine Wiles	FRACP
1996/7	Dr Ray Russo	FRACP FAFRM
1998/9	Dr Adam Scheinberg	FRACP FAFRM
2000	Dr Kate Hall (NZ)	FRACP FAFRM
2000/01	Dr Mithran Coomarasamy	FRACP FAFRM
2001/02	Dr Maria Kyriagis	FRACP FAFRM
2003	Dr Katie Banerjee (UK)	MRCPCH (UK)
2003/04	Dr Anna Blundell	FRACP
2004	Dr James Rice	FRACP FAFRM
2005	Dr Alexandra Baxter (UK	MRCP
2006	Dr Mike Forrester	FRACP
2006	Dr Sukanya De	FRACP
2007/08	Dr Eewei Lim (NZ)	FRACP
2007	Dr Natalie Snyman	FRACP

Post graduate Fellow in Paediatric Rehabilitation

2001	Dr Adam Scheinberg	FRACP FAFRM
2005/06	Dr Anna Blundell	FRACP
2007/08	Dr Antoinette Botman	MD

Musculo-Skeletal Fellow

2007/08

Dr Louise Tofts

FRACP FAFRM

(Adult) Rehabilitation Medicine Trainee

2003

Dr David Yu

MB BS

Honorary Paediatric Rehabilitation Trainees (Home City/Country)

2000	Dr Priya Jhamb (Brisbane)	FRACP FAFRM
2003	Dr Kate Leung (Hong Kong)	MRCPaeds (UK)

Advanced Paediatric Trainees ( 6 month attachments available)

Botulinum Toxin Training Program - National and International

2002	x2 Queensland and South Australia (Rehabilitation Paediatricians)
2003	x2 NZ (Paediatrician and Orthopaedic Consultant)
2004	x4 a month Japanese Neurologist and Orthopaedic Surgeons

Medical Staff

Clinical/Academic Staff Physicians

Physician	Specialist Qualifications	Positions
Dr Stephen O'Flaherty	FRACP FAFRM	Head of Rehabilitation Head of Inpatient Service Stepheno@chw.edu.au
Dr Jennifer Ault	FRACP FAFRM	Deputy Head of Rehabilitation AFRM - Paediatric Representative JennyA2@chw.edu.au
Dr Adrienne Epps	FRACP FAFRM	Head of Limb Deficiency Service eppsa@sesahs.nsw.gov.au
Dr Adam Scheinberg	FRACP FAFRM	Head of Muscle Management Rehabilitation Program AdamS2@chw.edu.auw
Dr Mary-Clare Waugh	FRACP FAFRM	Head of Spinal Cord Injury & Disease Service Head, Brain Injury Service MaryW@chw.edu.au
Dr Carolyn West	FAFRM	Head of Spina Bifida Service CarolynW@chw.edu.au
Paediatric Rehabilitation Trainees (2 positions)	Basic Medical Qualifications	Appointed for 12 months (Post Part 1 FRACP)
Paediatric Rehabilitation Fellows (Clinical & Postgraduate)	Basic Medical Qualifications	Appointed for 12 months (Post Part 1 FRACP)
Paediatric Advanced Trainees (up to 2 positions)	Basic Medical Qualifications	Appointed for 6 months (Post Part 1 FRACP preferred)
Honorary Fellows	Basic Medical Qualifications	Appointments as agreed to by Head of Department
(Adult) Rehabilitation Trainee	Basic Medical Qualifications	Appointed for up to 12 months

Introduction

The Children's Hospital at Westmead is a 350 bed freestanding, purpose-built children's hospital in Sydney's West. The hospital is affiliated with the University of Sydney and services the greater western area of metropolitan Sydney as well as suppling tertiary services to the state of New South Wales and parts of the South Pacific. Ten percent of all Australian children live within a 20 km radius of the hospital. The Royal Alexandra Hospital for Children has been caring for children for over 125 years and moved from inner Sydney to the present site in 1995 to be known as The Children's Hospital at Westmead

The Rehabilitation Department at The Children's Hospital at Westmead offers inpatient and outpatient services to infants, children and school-attending adolescents with physical disability and acquired cognitive disability. The inpatient service casemix is primarily children with:

• acquired brain injury
• spinal cord injury and disease.

These children are also cared for in the Rehabilitation ward by nursing, therapy, school and recreational staff.

There are also five outpatient services:

• brain injury
• physical disability (mainly children with cerebral palsy)
• spinal cord injury and disease
• spina bifida
• limb deficiency.

The connective tissue, neuromuscular and peripheral neuropathy services are consulted to by the Rehabilitation Physicians and trainees. The Muscle Management Rehabilitation Program focuses on spasticity management and research in to this area. The Brain Injury Service also has a comprehensive team of nursing and allied health personnel. These include:

• Case managers;
• cognitive therapist;
• clinical nursing consultants;
• clinical neuropsychologists;
• clinical psychologist;
• occupational therapists;
• physiotherapists;
• speech pathologist and social worker.

Training Positions

There are two positions for advanced trainees (ie after the registrar has passed the part 1 of the FRACP in Paediatrics). Both positions may be allocated to training Paediatric Rehabilitation trainees when they are offered on a 12 month basis and for up to 2 years. When these positions are filled by other advanced trainees from the General Paediatric training scheme, they are for a 6 month term. All trainees are attached to clinical Services and Programs within the Rehabilitation Department with the aim of gaining a comprehensive level of training in the assessment and management of childhood physical and acquired cognitive disability.

The formal training program for Paediatric Rehabilitation is for a minimum of three (3) years and the requirements are set by the Australasian Faculty of Rehabilitation Medicine (AFRM). As stated, Paediatric Rehabilitation Trainees are appointed for 12 months. Consideration will be given to trainees continuing in this post for a second year to complete their FAFRM requirements. These trainees are required to register with the AFRM program as a Paediatric Rehabilitation trainee and besides their training in Paediatric Rehabilitation trainees are able to attend training sessions organised by the NSW branch of AFRM for adult Rehabilitation Medicine trainees. Training courses in Upper and Lower Limb Prosthetic assessment and prescription are part of the requirements. A written and clinical (involving long and short cases) exit Fellowship examination in Paediatric Rehabilitation is set in the final year of training and must be passed to complete the Fellowship.

Overseas-trained candidates will be considered for positions and will need to be at a senior level of training in Paediatrics - equivalent to an advanced trainee, be eligible for registration with the joint training committee of the AFRM and RACP and be eligible for registration with the NSW medical board.

Job Descriptions:

A. Paediatric Rehabilitation Trainees

Grade: Medical Practitioner with basic specialist training in Paediatrics and currently in advanced trainee specialising in Paediatric Rehabilitation.

Status: Full-time Registrar (RMO) award- Twelve month appointment. Consideration will be given to trainees continuing in this post for a second year to complete their FAFRM requirements

Reporting to: Drs Ault, Epps, O'Flaherty, Scheinberg, Waugh and West for clinical matters relating to the day to day management of patients directly under the care of the rehabilitation service and those seen in consultation from other medical or surgical services.

Key Responsibilities, Duties and Activities

1. Medical management
1.1 To provide day to day medical management of the rehabilitation inpatients and to liaise with medical and surgical personnel involved in the primary care of patients seen in consultation by the rehabilitation service, under the supervision of Drs Ault, Epps, O'Flaherty, Scheinberg, Waugh and West.
1.2 Be involved in teaching ward rounds of the Rehabilitation Inpatient and the team conferences.
1.3 Work in conjunction with other members of the inter-disciplinary rehabilitation team to achieve the agreed goals by the team as part of each patient's rehabilitation management plan.
1.4 Liaise with medical, nursing, allied health personnel, school personnel and other community workers involved in the care of the patient.
1.5 To maintain patient records, write up summaries of team conferences and family meetings and to ensure a typed discharge summary is completed on all Rehabilitation patients prior to or at time of discharge from hospital,
1.6 To provide written reports as appropriate.
1.7 Provide information for Rehabilitation Department Database and maintain individual monthly statistics.

2. Inpatient Care
2.1 Attend the Monday 8.30am review meeting ("Huddle") in the Surgical Ward.
2.2 Be responsible for inpatient care of all children referred to Rehabilitation under the supervision of the Rehabilitation Department AMOs.
2.3 To see patients referred to the Rehabilitation Team, attending and participating in the ward rounds and family meetings.

3. Outpatient Clinics (see updated timetable)
3.1 Physical Disability Clinics (twice weekly) - includes Spinal Cord & Disease Service
3.2 Brain Injury Rehabilitation Clinic (weekly)
3.3 Rehabilitation Post-Clinic Meeting (weekly)
3.4 Orthotics Clinic at Westmead Hospital (monthly)
3.5 Spina Bifida Clinic (weekly)
3.6 Limb Deficiency Clinic (weekly)
3.7 Connective Tissue Clinic (weekly)
3.8 Neuromuscular Clinic (monthly)
3.9 Botulinum Toxin Clinics (three per week)
3.10 Peripheral Neuropathy Clinic (bimonthly)

4. Training/Teaching
4.1 NSW Rehabilitation Training Program
4.2 Teaching Round
4.3 Grand Rounds
4.4 Clinical review of all patients and reports by consultants

5. Research Involvement
5.1 One clinical review in the Rehabilitation area per six months.
5.2 One detailed research project over the twelve month attachment. This will require preparation of the project, submission for Ethics committee approval and submission for funding application. Completion of the project in the second year of attachment.

6. Administration
6.1 Departmental Meeting - minute taker
6.2 QA Committee
6.3 Research Committee

7 Hospital Policies

B. Paediatric Advanced Trainees (6 month position)

Grade: Medical practitioner with basic specialist training in Paediatrics or equivalent.

Status: Registrar (RMO) full-time award

Reporting to: Drs Ault, O'Flaherty, Scheinberg, Waugh and West (AMO's) for clinical matters relating to the day to day management of patients directly under the care of the Rehabilitation Service and those seen in consultation with other medical/surgical services

Key Responsibilities, Duties and Activities

1. Medical Management
1.1 To provide medical management for outpatients and designated inpatients of the Rehabilitation service under the supervision of Drs Ault, O'Flaherty, Scheinberg, Waugh and West.
1.2 To attend teaching rounds of Inpatient Rehabilitation Team.
1.3 To work in close co-operation with members of the Rehabilitation Team, to ensure that medical objectives are consistent with the aims of the team
1.4 To write up a summary of the family meetings and weekly team conferences on all inpatients and ensure this is recorded in each patient's medical record.
1.5 To ensure a typed discharge summary is completed on all inpatients prior to or at the time of their discharge from hospital
1.6 To participate in data collection for the Rehabilitation Department database as required by the Department of Health and for research purposes.
1.7 To participate in Rehabilitation Department continuing education programs.

2 Inpatient Care
2.1 Huddle" Monday 8.30 a.m. (Surgical Ward)
2.2 Spina Bifida Patients

3 Outpatient Clinics (see updated timetable)
3.1 Physical Disability Clinics (twice weekly) - includes Spinal Cord & Disease Service
3.2 Brain Injury Rehabilitation Clinic (weekly)
3.3 Rehabilitation Post-Clinic Meeting (weekly)
3.4 Orthotics Clinic at Westmead Hospital (monthly)
3.5 Spina Bifida Clinic (weekly)
3.6 Limb Deficiency Clinic (weekly)
3.7 Connective Tissue Clinic (weekly)
3.8 Neuromuscular Clinic (monthly)
3.9 Botulinum Toxin Clinics (three per week)

4 Teaching/Training
4.1 Teaching Rounds - (Surgical Ward)
4.2 Grand Rounds
4.3 Clinical review of all patients and reports by consultants

5 Research Involvement
5.1 At least one clinical review in the Rehabilitation area

6 Administration

7 Hospital Policies

C. Clinical/Postgraduate/Research Fellows

The fellow will be appointed for 12 months with an individual program as agreed to between the fellow and the head of Rehabilitation. Clinical and research fellows will need to be registered with the joint training committee of the AFRM and the RACP.

D. Honorary Fellows

May be appointed for any length of time for specific clinical, research of training purposes as agreed to with the fellow and the head of Rehabilitation.

E. Adult Rehabilitation Fellow

Appointment arrangements are at the discretion of the Head of Department. The primary aim of these positions is to familiarise adult Rehabilitation Medicine trainees with the management of conditions that have their onset in the Paediatric years. These are the conditions that the trainee will be managing once the adolescent has been transferred to an adult Rehabilitation service. These conditions include Cerebral Palsy, Connective Tissue Diseases, Spina Bifida as well as other Neuromuscular Diseases.

Working Environment

The Rehabilitation Department is located in the Children's Assessment Centre which is on the 3^rd level of the Outpatient block at The Children's Hospital at Westmead. The Rehabilitation Ward (Surgical Ward) is located nearby on the 2^nd level adjacent to one of the three hospital schools, the Physiotherapy, Occupational Therapy and Speech Pathology departments and the hydrotherapy pool. Inpatients are nursed in single, double and 4 bedded rooms with a purpose-built dining room and a multi-sensory room located on the ward. There are approximately 100 new inpatient admissions to the Rehabilitation service annually. Most outpatient clinics are held adjacent to the Rehabilitation Department offices. An orientation program is structured to familiarise each new appointee with personnel, procedures and policies in the department.

Trainees share a room and have their own computers with personal email and internet access. Trainees have full access to the Department support system including typing support from the 4 clerical staff. Outpatients are seen in the eight-room clinic area that is adjacent to the Rehabilitation Department. Investigations are accessed via the hospital network and medical imaging is digitised and accessible on dedicated computers in clinic areas. There is a full medical library and an extensive departmental library and resource room with information on local and state services. There are seventeen outpatient clinics per week and a number of children are seen off site by therapists and case managers. There are 14,000+ outpatient occasions of service annually. A copy of the departmental timetable for registrars is attached as an example.

Learning Directives for Trainees in Paediatric Rehabilitation Fellowship

Overall Goal:

The overall goal of the Fellowship is to train an individual so they reach a level where they are:

• Clinically proficient in unsupervised practice of Paediatric Rehabilitation Medicine
• Competent in teaching Paediatric Rehabilitation Medicine
• Competent in Research
• Competent in Administrative issues required to run a Paediatric Rehabilitation Service

Goal: Become clinically proficient in the acute rehabilitation management of the child with acquired brain injury and (acquired) spinal cord injury & disease

Implementation:

1. Become competent in the assessment of normal development of children
2. Become competent in assessment of children with neurological and musculo-skeletal sequelae after injury and disease.
3. Become competent in the medical management of problems occurring in the immediate period after the child's condition stabilising eg the management of increased tone, autonomic dysfunction, neurogenic bladder and bowel, pressure area care.
4. Become familiar with the problems associated with the child recovering from acquired brain injury and their management eg the aggressive child who is in post-traumatic amnesia
5. Become competent in communicating effectively with team members, families and other personnel involved in the child's management.

Goal: Become clinically proficient in the long term rehabilitation management of children with physical disability and acquired cognitive dysfunction.

Implementation:

1. Become competent in the assessment of upper limb function, gait and tone and the management options available.
2. Become competent in the management of behavioural and cognitive problems seen in children who have cerebral dysfunction
3. Become familiar with the adjustment process that children, and their families, may follow when they are born with or acquire a long term physical disability and how to intervene when this process becomes pathological
4. Become competent in assessment of limb deficiency and the prescription of prosthesis
5. Become competent in orthotic prescription

Goal: Develop and demonstrate Teaching competence

Implementation:

1. Develop teaching skills in the following settings:
• Informal bedside teaching
• Small group tutorials and presentations, including journal presentations, to junior medical staff
• Community, Parent and Support groups and allied health staff
• Presentations to the department and hospital meetings
• Presentations at national/international conference

Goal: Acquire Knowledge and skills needed to be a productive investigator

Implementation:

1. Protected time will be available for research
2. Become familiar with research design, ethics committee submission, grant application, hiring of research staff, implementation, writing up presentation and journal submission of completed research
3. Develop skills in appropriate software programs including Word, Excel, Reference manager, Powerpoint, Access and SPSS or another statistical package.
4. Trainees will be an active member of the department research Committee held immediately prior to the closing dates for Ethics committee submissions

Goal: Exposure to administrative management and issues in a Rehabilitation Unit

Implementation:

1. Become familiar with the third party insurance scheme for children involved in motor vehicle accidents in NSW.
2. Become familiar with medicolegal report writing
3. Develop skills in liasing with other hospital departments & community groups.
4. Become familiar with the structure and running of the Rehabilitation department including the role of the departmental meeting; Quality Improvement; Research and Executive committees.

Primary References

• Pediatric Rehabilitation G Molnar 3^rd Edition Rehabilitation Medicine Library. Wiiliams & Wilkins (library)
• Gait Analysis in Cerebral Palsy. Gage J R. Clinics of Developmental Medicine. MacKeith Press 1991 - (sjof)
• Physical Disability in Childhood: An Interdisciplinary Approach to Management. McCarthy G T (Ed). Edinburgh: Churchill Livingston 1992 - (mcw)
• The Child with Spinal Cord Injury. Betz R & Mukcahey M J (Eds). Americal Assoc Orthopedic Surgeons 1996 (mcw)
• Raising a child with a Neuromuscular Disorder. A guide. Thompson C E. Oxford Univ Press 1999. (mcw)
• Aids to the Examination of the PNS. Crown Copyright. Her Majesty's Stationery Office 1980 (mcw)
• P M & R Secrets. Young, Young & Steins. Hanley & Belfus 1996. (mcw)
• Neurological Rehabilitation. Optimizing Motor Performance. Carr J & Shepherd R. (bt)
• Educational Dimensions of ABI. Savage R & Wolcott G. (ot)
• TBI - Rehabilitation for Everyday Adaptive Living. Ponsford J. (ot)
• Policy and Procedures Manual - Rehabilitation Department - The Children's Hospital at Westmead (library)

Recommended Reading/Resource Materials

• Orientation Folder for registrars in Rehabilitation Department
• Brain injury Booklets "Step by Step"
• Brain injury Videos - (1) Step by Step (2) Moving On
• Rehabilitation Website: http://www.chw.edu.au/rehabilitation
• Treating Children with Botulinum Toxin - Rehabilitation Dept The Children's Hospital at Westmead

Journals:

• Developmental Medicine and Child Neurology
• Pediatric Rehabilitation
• Archives of Physical Medicine and Rehabilitation Medicine

Organisations/Websites

Cerebral palsy

• Australasian Academy of Cerebral Palsy & Developmental Medicine
• American Academy of Cerebral Palsy & Developmental Medicine www.aacpdm.org
• American Academy of Physical & Rehabilitation Medicine www.aapmr.org
• We Move www.wemove.org and www.wemove.org/kidsmove
• The Spastic Centre of NSW http://www.thespasticcentre.org.au/index.htm
• Cerebral palsy links page: http://www.lib.flinders.edu.au/resources/sub/education/cerebp.html
• USA CP site http://gait.aidi.udel.edu/res695/homepage/pd_ortho/clinics/c_palsy/cpweb.htm
• CP League of Queensland http://www.cplqld.org.au/sitemap
• Children's movement disorders http://www.wemove.org/kidsmove/ata.html
• Northcott Society http://www.northcott.com.au/
• General disability http://www.familyvillage.wisc.edu/index.html

Adult spinal cord injury sites and information sheets

• Queensland spinal services http://www.health.qld.gov.au/qscis/home.htm and http://www.health.qld.gov.au/SPOT/SPOTinfo.htm
• Australia http://www.paraquad.asn.au/Links/links.html
• NSW http://www.paraquad-nsw.asn.au/page.asp?partid=1
• USA http://www.sci-info-pages.com/index.html
• USA http://www.disability-resource.com/sci.html

Epilepsy

• http://www.epilepsy.org.au/epilepsy/epilepsykid.nsf

Muscular Dystrophy

• http://www.mda.org.au

Spinal Bifida

• Northcott Society: http://www.northcott.com.au