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Vocational Training
Palliative
Medicine
 Notice
for Trainees Commencing in 2007
Supervising Committee
Specialist Advisory Committee (SAC) in Palliative
Medicine.
Definition
of Specialty
Palliative care for children and young people with life-limiting
conditions is an active and total approach to care, embracing physical, emotional,
social, cultural and spiritual elements. It focuses on enhancement of quality
of life for the child and support for the family and includes the management of
distressing symptoms, provision of respite and care through death and bereavement.
General Principles- Advanced
training in paediatric palliative medicine is based on experience in both
palliative medicine and paediatrics.
- The emphasis for the trainee
is on clinical aspects of palliative medicine. This includes the diagnosis and
appropriate management of major symptoms (based on relevant pathophysiology) and
clinical pharmacology, and an awareness of a range of medical and non medical
options available for the management of palliative care patients.
- An understanding
of the range of conditions encountered in paediatric palliative care and the various
illness trajectories involved is also required.
- Whilst emphasis is on
the development of clinical skills, it is essential that an understanding be developed
of the principles of comprehensive palliative care and the role of the palliative
medicine physician in coordinating other professional staff.
- Experience
in a suitable training post outside Australia is encouraged. Early discussion
with the SAC is recommended to ensure suitability.
- An approved training
position in paediatric palliative medicine would fulfil the requirements for mandatory
training.
- All subspecialty paediatric trainees must complete the community
and child health requirements for paediatric training.
Note that the guidelines
differ between Australia and New Zealand.
Components of Training
Three years of training
is required.
Core Training
Core training
is 18-24 months in length, of which at least 12 months must be spent in an approved
paediatric palliative medicine training position. The other 6-12 months may be
spent in either an approved paediatric palliative medicine position or an approved
training position in adult palliative medicine. Ideally, the latter would involve
experience in both inpatient and community settings.
Non
Core Training
12-18 months of training may be spent in:- paediatric
haematology/oncology;
- paediatric neurology (developmental paediatrics);
- paediatric
rehabilitation medicine;
- paediatric respiratory medicine;
- paediatric
clinical pharmacology;
- paediatric pain management;
- paediatric
intensive care;
- neonatology;
- child and family psychiatry;
- adolescent
medicine;
- clinical genetics/metabolic medicine;
- research.
or
other training prospectively approved by the SAC.
All training programs
should be discussed in advance with the paediatric representatives of the SAC
in Palliative Medicine and must be approved prospectively by the SAC.
All training must be supervised by a specialist who holds the FRACP in Paediatrics.
Content
of Training
The content of training should include:- experience
in clinical decision making with particular emphasis on working with children
and their families;
- elucidation of clear goals of care and the development
of a management strategy in the light of personal priorities of the child and
family;
- experience in communication and counselling with children and
adolescents, their families and health care professionals, and for purposes of
support;
- assessment, diagnosis and management of various symptom complexes
(including various pain syndromes with due regard to medical and non medical measures);
- studies
of pathology, pathophysiology and clinical pharmacology of relevance to major
symptoms;
- experience in the application of ethical principles in the paediatric
setting;
- experience in addressing the psychosocial, cultural and spiritual
issues of dying patients and their families with particular regard for the developmental
influences on the experience of sick and dying children and their siblings;
- management
of psychiatric conditions in the palliative care setting including experience
in the use of psychotropic medication;
- experience in the ward and outpatient
and domiciliary situation of the problems encountered by the nursing staff in
palliative medicine;
- interdisciplinary contact with health professionals
from both paediatric and palliative care service systems, and experience in coordinating
care across a range of health care settings;
- development of skills in
team management and leadership.
The content of non core training in paediatric
services should reflect that of the palliative medicine component.
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