GULU UNIVERSITY FACULTY OF MEDICINE

DEPARTMENT OF PAEDIATRICS & CHILD HEALTH

Curriculum for Master of Medicine inPAEDIATRICS & CHILD HEALTH

JANUARY 2015

1

TABLE OF CONTENTS

2

List of AbreviationsCDC = Center for Disease Control and PreventionCGPA = Cumulative Grade Point AverageCH = Contact HoursCLH = Clinical HoursCMV = Cytomegalo virusCU = Credit UnitsGIT = Gastrointestinal TractHLA = Human Leucocyte AntigenHIV = Human ImmunodeficiencyIDI = Infectoius Disease InstituteLBW = Low Birth WeightLH = Lecture HoursMBChB = Bachelor of Medicine and Bachelor of SurgeryMHC = Major Histocompatibility ComplexMCQs = Multiple Choice QuestionsMMed = Masters of MedicinePH = Practical HoursPCR = Polymerase Chain ReactionTH = Tutorial HoursTB = TuberculosisRSV = Respiratory Synsytial VirusUTI = Urinary Tract Infection

3

1.0 BackgroundGlobally, more than 10 million children die every year, mainly in low-income countries or poor areas of middle-income countries. In Uganda children under the age of 15 years comprise 50% of the total population, while 20% are children under the age of five. Childhood, along with maternal conditions contribute the highest to Uganda’s total burden of ill health and preventable death. The health and future of the nations depends on the health and survival of this large but vulnerable group. The health of children must be considered as an important focus of national health agenda and public health efforts. Monitoring child morbidity and mortality is a key measure of national progress as reflected in the Millennium Development Goals. The post Millennium Development Goal agenda for child survival demands focused and coordinated action to, among other things, strengthen health systems, and to reduce inequalities in access to and use of effective interventions to prevent and treat childhood illness. This should include strengthening capacity for health leadership, training, development, implementation and monitoring of child health programs at all levels of health systems.The need for doctors with specialist training in Paediatrics and Child Health in Uganda was recognized in the 1960’s and training started towards the end of that decade. However, despite a number of paediatricians trained from Makerere College of Health Science, Mbarara University and recently from Uganda Martyrs University, the northern Ugandan and West Nile region still have few paediatricians. There still remains unacceptable high morbidity and mortality among children in the region. It’s against this background that Gulu University Faculty of Medicine has decided to establish the Master of Medicine in Paediatrics and Child Health program, to contribute to the goal of improving the health and survival of children through the training of scientifically sound, clinically competent and locally appropriate child health specialists. A paediatrician and child health specialist in a resource poor country like Uganda has many roles, which include diagnosis, management, and prevention of diseases of children, promotion of child health and advocacy for children’s rights, research, training and provision of health leadership. This means that the paediatrician must be both clinically sound and able to recognize the wider community and societal issues involved in the causation of child health problems and provide leadership in solving these problems.The discipline of Paediatrics and Child Health incorporates the teaching, practice and promotion of all aspects of children’s well being. During the training of postgraduate doctors previous grounding in the basic medical sciences will be reinforced, education in growth, development and nutrition will be emphasized and the impact of child health on the well being of the family and community will be recognized. Students will learn about assessment, treatment and control of the common diseases affecting children, as well as about Child Health policies and the importance of, and avenues for the pursuit of effective child advocacy. 2.0 Nomenclature:The programme shall be called Master of Medicine in Paediatrics and Child health (MMED Paediatrics). Successful graduates will be awarded the master of Medicine in Paediatrics and Child Health of Gulu University.2.0 Vision of the Department of Pediatrics & Child Health To be a pillar of academic excellence, innovations and professional child health training3.0 Mission of the Department of Pediatrics & Child Health

4

To enhance and advocate for the health of children through quality professional training, research and equitable service delivery 4.0 Philosophy of the graduate programA paediatrician and child health specialist, as a leader of a child health team is to be competent in all areas of child health and development other than patient care alone. The broad objectives of the program are:

1. To provide a sound scientific and professional paediatrician who would be capable of working anywhere in Uganda and worldwide.

2. To create child health specialists with sufficient management ability to provide leadership in health care delivery.

3. To Participate in the training of other health professionals and communities in child health

4. Participate in continuing professional development.5. Designing, implementing and utilizing research findings6. Management of resources for health.7. Effective child health advocacy

5.0 Programme GoalThe goal of the MMED (Paediatrics & Child Health) program is to maintain and achieve further excellence in the training of a paeditrician in patient care, research and promotion of child and adolescent health in the community. Additionally, the program will provide experience in diversified field of paediatric and intellectual environment that is conducive to learning and exemplary practice. The program will focus on educating, and facilitating the students to acquire in depth knowledge, relevant skills and professional qualities that form the basic foundation in General Paediatrics and Child Health.6.0 Programme ObjectivesThe specific objectives of the programme are to produce graduates (general peadiatricians) with the following:General objectivesThe Programme is designed to train specialists so that they achieve the following competencies:

Equipped with scientific knowledge, skills and the right attitude to carry out comprehensive clinical evaluation and appropriate care of children.

Equipped with knowledge and skills in primary health care and community health. Equipped with knowledge and skills to conduct research. Capable of analyzing global child health issues and linking them to advocacy and policy

development. Capable of effective communication skills and functional team member. Equipped with knowledge and skills in basic sciences, diagnoses, ethics and counseling.

Towards these general objectives the graduate will be expected to attain the following competences: 1 – Professional medical KnowledgeGraduate student should demonstrate the ability to integrate previously attained knowledge of basic sciences, epidemiology and social-behavioral sciences in holistic care of children, families and society.

5

Sub-competenciesi) Describe the molecular, biochemical and cellular mechanisms important to maintain the

body’s homeostasis in newborns, children and adolescentii) Explain the pathology and pathophysiology of the major organ systems that are in

newborns’ and childhood diseases and condition.iii) Apply epidemiological knowledge of common diseases within a defined population in

order to reduce disease burdeniv) Apply evidence based medical knowledge to provide quality service delivery.v) Recognize the etiology of newborns and childhood disease and the ways in which they

affect the body.vi) Interpret relevant diagnostic investigations such laboratory, imaging and histopathologic

studies.

2- Clinical Skills and Patient Care Graduates should demonstrate effective use of clinical skills in diagnosis, management and prevention of common child and adolescent health problems.Sub-competencies

i) Obtain a comprehensive and focused paediatric history in a respectful, logical and organized manner.

ii) Perform a thorough paediatric examination in a respectful, logical and organized manner.

iii) Perform all the procedures to take care of the small birth weight newborn.iv) Perform common technical procedures used in paediatric practice. v) Make appropriate diagnostic and therapeutic management plans for the care of

paediatric patients based on evidence based medical practice. vi) Coordinate a multi-disciplinary team in the management of chronic childhood health

problemsvii)Effectively work in partnership with the patient, family, health care team, and other

parties in order to achieve the best possible child health care outcomes. viii) Utilize appropriate technology to enhance the practice of paediatrics and

the delivery of child health care services.

3 - Research methodGraduates should demonstrate an understanding and use of scientific theory, methodology and critical thinking skills to conduct research, interpret findings and apply these to improve child, family and community health.Sub-competencies

i) Demonstrate an understanding of the ethical, legal, professional and social issues applicable in the design and conduct of research.

ii) Demonstrate the ability to make use of personal observations in routine child health careiii) Demonstrate the critical thinking needed to apply basic, clinical and population research

to improve child, family and community health.iv) Demonstrate the ability to design and implement a research project.

4 - Professionalism and ethical practice

6

Graduates must demonstrate a commitment to carry out a professional responsibility, adherence to ethical principles and sensitivity to diversity. Sub-competencies

i) Accepting responsibility for patient care including continuity of careii) Demonstrating integrity, honesty, compassion empathy in one’s role as a paediatricianiii) Respecting the patient’s privacy and autonomy and maintaining appropriate professional

boundariesiv) Apply appropriate scientific standards for quality health care delivery.v) Demonstrate accountability and commitment to patient, society and the professionvi) Demonstrate a responsiveness to the needs of patients and society that supersedes self-

interestvii)Demonstrate high standard of ethical behavior and self awareness of one’s own knowledge,

skills and emotional limitation that leads to appropriate help seeking behaviorviii) Demonstrating sensitivity and responsiveness to patients’ and colleagues’

gender, age,  culture, disabilities, ethnicity, and sexual orientation

5 - Interpersonal and Communication Skills Graduate should demonstrate competency in interpersonal and communication skills, which results in effective information exchange working with patients, their families, and other health professionals.  Sub-competencies

i) Communicating effectively in a developmentally appropriate manner with patients and families to create and sustain a professional and therapeutic relationship across a broad range of socioeconomic and cultural backgrounds

ii) Communicating effectively with paediatricians, other health professionals, and health related agencies

iii) Working effectively as a member or leader of a health care team or organizationiv) Being able to act in a consultative role to other health professionalsv) Demonstrate ability to maintain comprehensive, timely, and legible medical records. vi) Demonstrate the insight and understanding into emotion and human response to

emotion that allows one to appropriately develop and manage human interactionvii)Demonstrate effective and appropriate listening, verbal, non-verbal and written

communication skills with and about patients to children, family, colleagues, and public.

6 - Leadership & Management Graduates should demonstrate appropriate leadership and management skills for effective and efficient health systemsSub-competencies

i) Demonstrate an understanding of the principles of leadership and management.ii) Apply the leadership and managerial skills during the provision of health care.iii) Demonstrate the ability to mobilize and utilize health care resources.iv) Demonstrate the ability to provide mentorship to team members.v) Demonstrate entrepreneurship skills in the provision of health care.vi) Demonstrate the ability to manage and utilize health information systems.

7

7 - Community Health Skills Graduates should demonstrate the ability to work with the community to promote child health, prevent disease and empower communities to solve local health problemsSub-competencies

i) Demonstrate an understanding of community dynamics.ii) Apply knowledge, strategies and skills for community empowerment for their health and

for child health.iii) Apply knowledge of social and environmental determinants of health to promote child

health, community health and wellbeing.iv) Demonstrate the ability to work with the community to promote child health and prevent

diseases.v) Demonstrate ability to use epidemiological and statistical principles in the analysis and

interpretation of health data.

8 - Practice based learning and continuous improvementGraduates should demonstrate competence in the use scientific methods and evidence to investigate, evaluate, and improve their patient care practices. Sub-competencies

i) Taking primary responsibility for lifelong learning to improve knowledge, skills, and practice performance

ii) Analyzing one’s practice experience to recognize one’s strengths, deficiencies, and limits in knowledge and expertise

iii) Incorporate formative evaluation feedback into daily practice. iv) Systematically analyze practice using quality improvement methods, and implement

changes with the goal of practice improvement. v) Using evaluations of performance provided by peers, patients, superiors, and

subordinates to improve practice and optimize learningvi) Locate, appraise, and assimilate medical evidence from scientific studies related to child

and adolescent health problemsvii)Using information technology to optimize lifelong learningviii) Actively participating in the education of patients, families, students,

residents, and other health professionals

9 - Health Systems Management Graduates should demonstrate an understanding of the composition, organization, economics and other interrelated dynamics of health service provision and the ability to practice within the health system.Sub-competencies

i) Describe the different players in health delivery and enabling functions, such as stewardship, financing, and resource generation, including the health workforce.

ii) Discuss local and global health trends.iii) Analyze the legal and policy frameworks of health deliveryiv) Explain the different sources of health care and health seeking behaviorsv) Describe the structure of the health care system in the country

8

vi) Demonstrate ability to work with different partners in health carevii)Demonstrate ability to work at different levels of the health care system

7.0 ResourcesThe funding sources for the M.Med. Program includes students’ fees, University funds, donations from friends linking universities and research grants. The majority of clinical training will be done at Gulu Regional Referral Hospital and St. Mary’s Hospital Lacor. Facilities include: 2 Paediatric wards, 2 Newborn units, 2 premature units, 2 malnutrition unit, 1 acute care unit, 1 cancer unit, general and specialized outpatient clinics.The existing manpower includes 6 Ugandan Paediatricians and visiting specialists in Paediatrics from Uganda and abroad.Postgraduate students have access to the faculty library, journals and textbook donated by visitors’ form linking institution. They also have access to computers and Internet access.

8.0 General RegulationsThe common regulations and guidelines for Masters Degree of Gulu University shall be applicable. To be eligible for admission to a Masters degree Programme, a candidate must have a CGP average of 3 and above from a recognized institution.

9.0 Admission Requirements1. MBChB or its equivalent from a recognized University2. Evidence of completion of 1 year of internship3. Full registration with the Uganda Medical and Dental Practitioners Council4. At least one year’s experience in clinical practice as a registered medial practitioner.5. The Department of Paediatrics and Child Health shall review all applicants and make

recommendations to the Faculty of Medic ine and the University higher Degrees Committee.

10.0 Design of the CurriculumThe curriculum is designed using the SPICES model for curriculum planning and implementation. In this context the programme is student centered, case based, integrated, community oriented and organized in a systematic approach in teaching all the prescribed courses. The students will have opportunities to undertake an elective course in health facilities outside the department and the hospital. In this context the curriculum is competency based; integrated and innovative teaching, learning and assessment methods will be applied in its implementation. The programme is designed around acquisition of knowledge, development of skills and professional qualities through practical experiences in hospital facilities and in the communities. The integration will involve teaching of biomedical sciences, common courses, and clinical rotational courses during the 3-year training period. The programme provides for graded responsibilities over the training period, and the student will be closely supervised and guided from the first to the third year of training. On completion of the training, the graduate will have developed measurable qualitative and quantitative knowledge, competencies and professional qualities that are relevant in critical thinking, clinical reasoning and problem solving in the management of paediatric and child health problems and conditions in various environmental settings. The programme will focus on the development of core competencies and

9

skills that are essential in providing quality health care services in paediatrics and child health and also in other related disciplines. The programme is designed to enable the students to continue taking theoretical courses as they continue with clinical rotations during the four years of training on diagnosis and management of various conditions in paediatrics and child health. The implementation of the programme will enable the residents to have teaching sessions during clinical rotations in the three years of training, mostly given at the afternoon hours.

11.0 Duration of the programmeThe programme is a full time three-year programme conducted on a credit unit basis. There will be lectures, tutorials, demonstrations, journal clubs, grand rounds, mini-rounds, radiology rounds and bedside teaching. The student will undertake both supervised and unsupervised clinical practice in outpatient as well as inpatient areas. In addition they will carry out clinical patient care procedures. Duration of Semester will be 17 weeks with 15 weeks tuition and 2 weeks examination.

12.0 Methods of deliveryA variety of methods will be used to enable the students’ meet the stated objectives of the

program and acquire the expected competences. These methods include: Overview lectures Case based learning

o Clinical work / apprenticeship – both on the wards and in the outpatient clinics o Tutorials o Experiential learning – through reflections and personal diaries/portfolios

Self-directed learningo Experiential learning – through reflections and personal diaries/portfolioso Seminars o Workshops o Skills training

Demonstrations: of clinical & communication skills, professionalism, leadership and clinical inquiry

Mini rounds and case discussions Grand Rounds, symposiums and scientific conferences/meetings Journal Clubs Practicals (e.g. side lab and procedures) Community attachments/projects, electives and exchange program Teaching of medical students, other health workers and caregivers and communities

Priority will be given to the learning-by-doing philosophy, putting guided and surveyed practices in the first line, spread out across the week days regularly. Formal teaching (lectures and seminars) will be preferably given during the afternoon hours, in order to allow the tutors and the students to participate to the direct care of the newborn and the sick child, especially during morning hours.

1. Methods of Assessment10

Progressive assessment: Student will be continuously assessed during the course using portfolios and logbooks. Progressive assessment of knowledge will comprise of case written examinations, take home and log books. Attitudes interest and skills will be continuously assessed by observation and feedback. The progressive examination will comprise of 40% of the end of course marks.Summative assessment: Will be in form of a writing examination comprising of Multiple Choice Questions, modified essay questions, long and short cases, Viva voce and Objectively Structured Clinical Examinations (OSCE). The summative assessment of the course will contribute 60% of the total end of course marks. 13.0 Assessment and Grading

Each course will be assessed in two parts:i) Course work (Progressive Continuous Assessment) contributes 40%. It may be revised

according the University policy. Continuous assessment shall consist of a number of methods that will be used to assess the various expected outcomes/competencies including but not limited to ward assessment, continuous observation and feedback (by peers, teachers, others) during the learning experiences, assignments, tests, logbooks/port folios and case write-ups or assignments.

ii) Summative or End of semester examinations, which shall contribute a maximum of 60% of the total marks. Summative assessment shall consist of a number of methods that will be used to assess the various expected outcomes/competencies including but not limited to written examinations (MCQs, modified essay questions, short answer questions), Objectively Structured Clinical Examinations (OSCE), Objectively Structured Practical Examinations (OSPE), project reports and vivas.

iii) The specific method used for assessment may vary across the different phases of the curriculum, based on the expected competencies for each course.

iv) Each course will be graded out of a maximum of one hundred (100) marks and assigned appropriate letter grades and grade points as follows:

Marks % point Later Grade Grade80 - 100 A 575 - 79.9 B+ 4.570 - 74.9 B 4.065 - 69.9 B- 3.560 64.9 C+ 3.055 59.9 C 2.550 - 54.9 C- 2.0 Pass Mark45 - 49.9 D+ 1.540 - 44.9 D 1.035- 39.9 D- 0.5Below 35 E 0.0

v) The Pass Mark in any courses shall be 50% and it may be revised according to University policy

vi) No credit unit should be awarded for any course in which a student fails.

11

Retaking a course or coursesi) A student shall retake a Course or Courses when next offered in order to obtain at least

the Pass mark of 50%.ii) A student who failed to obtain at least the Pass Mark (50%) during the Second

Assessment in the same course or Courses he/she has retaken shall receive a written warning.

iii) A student may retake a Course when next offered again in order to improve his/her Pass Grade(s) if the Pass Grade got at the first Assessment in the Course or Courses was low.

iv) While retaking a Course or Courses, a student shall: -a) Attend all the prescribed lectures/tutorials/ Clinicians/ Practicals/Fieldwork in the

Course or Courses at least 75%;b) Satisfy all the requirement for the Coursework component in the Course or

Courses and;c) Sit for the University examinations in the Courses or Courses

Normal progress:Normal progress occurs when a student has passed each of the specified courses with a minimum grade point of 2 and has a CGPA of 2 or above.Probationary progress:A student shall be placed on probation;a) When he/she fails a core course orb) If his/her GPA or CGPA is less than two (2.0).When the GPA of a student goes up to 2.0 or above and he/she has passed all compulsory core courses in the following relevant semester, then the probationary status is removed. The probationary status serves as a warning to students that their performance is below the required level.Staying put:A student shall stay put under any of the following conditions;When a student has more than two retakes in a particular semester, the student shall stay put and not proceed to the next semester or year of study. He/she can be allowed to move on probationary progress if he/she passes some of the courses and reduces the number of retakes to below two.If any student has a retake in year one and/or year two of study, he/she shall not be permitted to proceed to year three of study unless he/she has passed the retakes in year one and/or year two.Discontinuation:

a) When a student accumulates two consecutive probations based on CGPA he/she shall be discontinued.

b) A student who fails to obtain at least the Pass Mark (50%) during the Third Assessment in the Same Course or Courses he/she had retaken shall be discontinued from his/her studies at the University.

c) A student who has overstayed in an Academic Programme by more than Two (2) years shall be discontinued from his/her studies at the University.

12

Withdrawal from a programme or course:A registered student may choose to withdraw from a programme/course(s) for various reasons such as social, health and financial reasons. Such a student can resume the programme/courses within three years if the cause of the withdrawal is not unsatisfactory progress or conviction for a criminal case.

Failure of a Core or Prerequisite Course:When a student fails in a prerequisite course with a mark from 40% and 50%, i.e. GP below 2 but 1 or above, he/she shall be allowed to proceed to the next semester/course and retake the failed course when next offered and without penalty. If the level of failure is very bad i.e. less than 40%, then the student should not be allowed to proceed to the next course but to wait and retake the failed course when next offered.Compensation:All courses must be passed in its own right. No compensation will be done in any point when results move through presentation and approval by University organs (Faculty board, Senate & Council)Retaking of a course:A candidate can retake a course so as to pass it if he/she had failed it before or to improve the grade if the first pass grade was low. The Transcript will indicate so if done. Retaking a course means attending lectures, doing required progressive course work and sitting the end of course examinations.Absence from examination

ii) If the faculty of medicine finds out that a student has no justifiable reason for having been absent from a particular examination, such a student shall receive a fail (F) Grade for the Course(s) he/she had not sat the examination in. The Course(s) in which the Fail (F) Grade was/were awarded shall also count in the calculation of the CGPA.

iii) If the faculty of medicine is satisfied that a student was absent from a final examination due to justifiable reasons(s) such as sickness or loss of a parent/guardian, then a Course Grade of ABS shall be assigned to that Course(s). The student shall be permitted to take the final examination when the Course would be next offered or at the next examination season if the Course coordinator concerned can make the appropriate arrangements for the examinations.

12.0 Dissertation Submission of the dissertationa) A candidate shall not be permitted to formally start on research work unless he/she has

passed the taught course in the second year.b) A candidate shall conduct research in a chosen area with the guidance of two

supervisor(s). The candidate will initially present the intended research work proposals at a departmental meeting.

c) A candidate shall submit a research proposal to the institutional review committee before the end of the first semester of the second year and begin the research component during the second semester of the second year.

13

d) The candidate shall present their research findings in the form of a Dissertation in accordance with common University Rules and Regulations for a Masters Degree in all Faculties.

e) A candidate intending to submit his/her dissertation/thesis must give three months written notice of submission to the Director, School of Postgraduate Studies and must be endorsed by the Supervisors and Head of Department.

f) When the candidate’s dissertation/thesis is ready for submission, he/she should submit three loose bound copies with the authority of the supervisors and Head of Department direct to the Director, School of Postgraduate Studies.

g) The dissertation/thesis must be presented at least three months before the date of the final examination. The first 4 weeks of semester 2 year 3 will be for finalizing the dissertation.

Passing of DissertationTo pass the Dissertation the candidate shall satisfy the Examiners in both the written Dissertation and Viva Voce.

Revised DissertationA candidate who fails to satisfy the examiners shall re-submit a revised Dissertation in accordance with the guidance of the Viva Voce Committee.A candidate shall re-submit the revised Dissertation within six months after notification.Only one re-submission of a Dissertation is allowed.

2. Resources and Infrastructure available Wards and outpatient clinics Patients / clients Simulated patients Lecture rooms Office space for staff Library Laboratory Book bank Seminar rooms Computer labs with internet facilities Specialized equipment Audio-visual aides E-books Placement

3. GENERAL References for the courseTextbooks

Behrman R W, Kliegman R M, Jenson H B. Nelson Textbook of Pediatrics. W.B. Saunders Company

Stephenson T, Wallace H. Clinical Paediatrics for Postgraduate Examinations. Churchill Livingstone

Stanfield P et al. Eds. Diseases of Children in the Subtropics and Tropics. Arnold Hutchisons Clinical Methods Advanced Paediatric Life Support. BMJ Books.

14

ETAT+ Manuals, Protocols and Guidelines The Harriet Lane Handbook. Elsevier Mosby

Journals New England Journal of Medicine Pediatrics (American Academy of Pediatrics) Archives of Disease in Childhood (RCPCH-UK) Annals of Tropical Paediatrics and International Child Health Journal of Tropical Paediatrics Pediatrics in Review

Teaching Staff No. Name Qualifications Employer Status1 Dr Aliku Twalib MBChB, M.Med. Gulu University Fulltime2 Dr Joyce Moriku Kaducu MBChB, M.Med, Gulu University Fulltime3 Dr Beatrice Odongkara Mpora MBChB, M.Med. Gulu University Fulltime4 Dr Ruth Lanyero MBChB, Gulu University Fulltime5 Dr Nyeko Richard MBChB, M.Med. Lacor Hospital Honorary6 Dr Byaruhanga Charles MBChB, M.Med, Lacor Hospital Honorary7 Dr Bongomin Bodo MBChB, M.Med. MOH Honorary8 Dr Valeria Calbi MBChB, Lacor Hospital Honorary

15

1. YEAR I: SEMESTER ICODE COURSE TITLE LH TH PH CH CUAR Clinical Methods and emergency paediatrics 1 4

Medical ethics & Gender concepts 2Growth, development & Genetics 3Infectious diseases, immunology & allergic diseases 4Principles of teaching & learning 2 TOTAL SEMESTER CU 15

YEAR I: SEMESTER IICODE COURSE TITLE LH TH PH CH CU

Clinical Methods and emergency Paediatrics II 4Neurology 4Nutrition & Gastroenterology 3Nephrology 3

TOTAL SEMESTER CU 14

YEAR I: RECESS TERMCODE COURSE TITLE LH TH PH CH CU

Health system management (COBERS) 3Social & Community child health (COBERS) 3

TOTAL SEMESTER CU 6

YEAR II: SEMESTER ICODE COURSE TITLE LH TH PH CH CU

Neonatology 4Child & Adolescent Mental Health 4Basic epidemiology, statistics and applied research methods 4

TOTAL SEMESTER CU 12

YEAR II: SEMESTER IICODE COURSE TITLE LH TH PH CH CU

Hematology & Oncology 3Internal Medicine & Dermatology 4Cardiology 4

TOTAL SEMESTER CU 12

YEAR II: RECESS TERMCODE COURSE TITLE LH TH PH CH CU

Elective

TOTAL SEMESTER CUYEAR III: SEMESTER I

CODE COURSE TITLE LH TH PH CH CU16

Clinical Methods and emergency Paediatrics III 4Pulmonology 3Endocrine & Metabolic disorder 4Emerging & re-emerging diseases 2 TOTAL SEMESTER CU 13

YEAR III: SEMESTER IICODE COURSE TITLE LH TH PH CH CU

Clinical Methods and emergency Paediatrics IV 4Paediatrics & Child health policy development 3Dissertation writing, Presentation & Defense 5

TOTAL SEMESTER CU 12

Curriculums Benchmarks:Total Practical Hours: Over ----- Hours. Total Credit Units: 84 Credit Units

17

DETAILED OUTLINE OF EACH COURSEYEAR ONE

MMM---: Clinical Methods and Emergency Paediatrics I 4. Credit Units: 4.05. Year when Course is taught: Semester 1, Years One6. Course Description

In this course, the students will learn the clinical skills of assessing and managing children with childhood diseases and illnesses, including emergencies. The course will also enable the students to learn the etiologic factors, presentation and management of common paediatric emergencies.

7. Course aimTo equip the students with the competences required to urgently and skillfully manage sick children

8. Course Objectives / Expected outcomes By the end of this course the student should be able to:1) To demonstrate the ability to identify critical sick children2) To be able to do a fast and complete examination of the child and the newborn3) To demonstrate the ability to handle common Paediatric problems including emergencies.4) To demonstrate the ability to manage life threatening conditions in childhood5) To demonstrate the ability to use resuscitation equipment6) Identify relevant investigations in the management of a sick children7) Perform relevant investigations in the management of a sick children8) To apply the knowledge of generated data in managing of paediatric children9) To demonstrate appropriate ethical and professional contact in the management of paediatric

patient10) Appropriate communication and multi-disciplinary team work skills to handle paediatric emergencies

9. Course Content outline Physical exam of the newborn and child Paediatrics Basic Life Support systems Paediatrics emergencies handled Common Paediatric clinical problems Ethical and legal aspects of cardiopulmonary resuscitation Appropriate communication in emergencies Cardiovascular emergencies Hematological emergencies Respiratory emergencies Neurological emergencies Neuropsychiatry emergencies Accidence and poisoning Use of emergency equipments Use of emergency medicines Common diagnostics tests and imaging studies

18

MMM---: Medical ethics & Gender concepts 1. Credit Units: 2.02. Year when Course is taught: Semester 1, Years One3. Duration of the Course: 5 Weeks4. Course Description

This course is intended to cover topics on the principles of medical ethics and ethical code of conduct. A system of moral principles that apply values and judgment to the practice of medicine

5. Course aimStudents will be able to recognize the impact of their professional attitudes and behavior on children and consistently demonstrate high standards of excellence, duty, and accountability to patients, communities and policy makers. Students should acquire knowledge and skills of applying gender concepts in their practice of Medicine

6. Course objectives / Expected outcome: 1) Maintain ethical standards (confidentiality, informed consent, avoid practice errors, avoid

conflicts of interest) 2) Show respect, compassion, and integrity while interacting with patients, their families,

clients, communities and health professionals 3) Advocate and implement fair and evidence based distribution of health care resources in

Uganda 4) Apply the basic ethical principles, including confidentiality, informed consent, truth

telling, and justice for conduct of research, dissemination of scientific knowledge and decision making

5) Enable students apply gender concepts in child health research, teaching, patient handling, monitoring and evaluation

7. Course content outline1) Code of conduct (Etiquette of health Professionals)2) Ethical obligation3) Standards of professional practice4) Terminal care and end of life issues5) Cross cultural and religious issues that affect health ethics and human health6) Address ethical dilemmas in clinical practice7) Rights and Responsibilities of patients and health care providers8) Research ethics9) Inter-professional and multidisciplinary relationships10) Human rights and Children’s rights

Gender concept

Aim: Students should acquire knowledge and skills of applying gender conceptsObjectivesEnable students apply gender concepts in child health research, teaching, patient handling, monitoring and evaluationCompetencesPractical skills in use of gender analytic tools in child health

19

10. Course coordinator:Dr Twalib Aliku

12. References The law and ethics of medical research by Aurola plumer Medical ethics by John Rayno William Black well guide to medical ethics by Rosamond Rhodes lezzly p francis & Annita Ethics by A. Odonga, Marianum Press (U) Uganda Medical and Dental Practitioners’ Council Handbook on Professional code of

conduct

CODE: Growth, Development and Genetics1. Credit Units: 4.02. Year when Course is taught: Semester 1, Years One3. Duration of the Course: 5 Weeks4. Course Description

This course enables students to learn about growth and development, genetic disorders and chromosomal anomalies, congenital abnormalities in children and screening for disorders. Course AimTo equip the students with the knowledge and skills required to assess growth and development of children, and manage children with genetic and congenital disorders and understand what screening tests to request.Course objectives / Expected outcomeBy the end of this course, the student should be able to:

Discuss growth and development commencing from intra-uterine life to adolescence. Discuss common genetic disorders and congenital abnormalities in children Apply the knowledge acquired in the clinical care of children. Demonstrate counseling skills in education prospective parents on chromosomal and

genetic disorders Demonstrate skill to screen for prenatal genetic and congenital anomalies

Course Content outline: Growth and development Physiology of Puberty Normal growth patterns in children and adolescence Assessment of growth and development Genetic disorders and birth defects In born errors of metabolism Systemic embryology Principles of genetics and inheritance Prenatal screening for genetic and congenital anomalies Basic molecular genetics and gene therapy Genetic counseling

20

References1. Jones. Smith’s recognisable patterns of human malformation. Saunders

CODE: Infectious Diseases, Immunology and allergic disorders

1. Credit Units: 4.02. Year when Course is taught: Semester 1, Years One3. Contact Hours: 604. Course Description

In this course, the students will learn the principles of immunology, and acquire an in-depth understanding of common immunological, allergic and infectious diseases in childhood.

5. AimsTo equip the students with knowledge and skill about common immunological, allergic and infectious diseases in childhood.Course Objectives /Expected outcomeBy the end of this course, the student will be able to:

1. To understand and apply the principles of immunology.2. To apply the knowledge of infectious disease one etiology, pathophysiology and

management of common childhood infectious diseases.3. Demonstrate skills of immunological and allergic diseases4. Demonstrate appropriate principles of therapeutics in the management of infectious and

allergic disease5. Identify and perform diagnostic investigations for the management of a child with

infectious, immunological and allergic disease6. To demonstrate appropriate ethical and professional contact in the management of

paediatric patient

Course Content outline: Principles of immunology Common immunological disorders and allergic disorders Vaccines and Immunization Patho-physiology presentation, diagnosis and management of childhood infectious diseases Rational use of therapeutic agents Primary immune deficiency syndromes Secondary immune deficiency syndromes Common bacterial infections (TB, pneumonis) Common virus disease (HIV, Hepatitis, CMV, Protozoan infections (Giardia Lamblia ) Nosocomial infectious Allergic disorders (Asthma, eczema, food allergy, conjunctivitis, etc ) Investigation on infectious disease and allergic conditions

References2. Stanfield P et al. Eds. Diseases of Children in the Subtropics and Tropics. Arnold

21

3. Tindyebwa D, Kayita J, Musoke P, Eds. Handbook on Paediatric AIDS in Africa. ANECCA.

4. Crofton J, Horme N, Miller F. Clinical Tuberculosis. IUATLD.5. WHO/FCH/CAH/00.1. Management of the child with a serious infection or severe

malnutrition. Guidelines for care at the first-referral level in developing countries. WHO6. The Red Book7. The Pink Book8. David Salisbury et al. Eds. The Green Book: Immunization against infectious diseases.

Department of Health9. Cook. Manson’s Tropical Diseases. Saunders10. Peters and Gilles. Tropical Medicine and Parasitology. Wolfe. 11. Hospital care for Children. WHO12. Paediatrics in the tropic by R G Hendrickse

FIRST YEAR – SEMESTER IICODE: Clinical Methods & Emergency Paediatrics II

1. Credit Units: 4.02. Year when Course is taught: Semester 1I, Years One3. Contact Hours: 604. Course Description

In this course, the students will build on the clinical skills and competences acquired during year one semester one (Code)

5. AimsThe student should demonstrate the ability and competences to effectively manage emergency childhood conditions

6. Course objectives / Expected outcomeBy the end of this course the student should be able to:1. To demonstrate the ability to identify critical sick children2. To perform a problem-oriented complete physical examination of the patient3. To demonstrate the ability to handle common Paediatric problems including emergencies.4. To demonstrate the ability to manage life threatening conditions in childhood5. To demonstrate the ability to use resuscitation equipment6. Identify relevant investigations in the management of a sick children7. Perform relevant investigations in the management of a sick children8. To apply the knowledge of generated data in managing of paediatric children9. To demonstrate appropriate ethical and professional contact in the management of paediatric

patient

7. Course Content Paediatrcs Advanced Life Support systems Use of Information and technology in critical inquiry in management of childhood disease Teamwork in managing childhood diseases Paediatrics emergencies handled Common Paediatric clinical problems Ethical and legal aspects of cardiopulmonary resuscitation

22

Appropriate communication in emergencies Cardiovascular emergencies Hematological emergencies Respiratory emergencies Neurological emergencies Neuropsychiatry emergencies Accidence and poisoning Use of emergency equipments Use of emergency medicines Common diagnostics tests and imaging studies

ReferencesTextbooks :See previous

CODE: Neurology1. Credit Units: 4.02. Year when Course is taught: Semester II, Years One3. Contact Hours : 604. Course Description

In this course, the students will learn about neurological disorders in childhood. 5. Aim

To equip the students with the appropriate knowledge and skills required to manage central nervous system disorders in childhood and adolescence.

6. Course objectives / Expected outcomeBy the end of this course, the student should be able to:

1. Applied anatomy and embryology of the brain2. Describe the advanced principles of neurophysiology3. To be able to explain pathophysiology of CNS condition 4. Descript the disorders affecting the central nervous system5. Demonstrate the ability to elicit interpret clinical features and manage the

disorder of CNS.6. To investigate and appropriately interpreted a child with CNS condition7. To investigate and appropriately interpret a child with CNS disabilities8. Recognize and treat seizures in children9. Recognize and treat Neuro-muscolar disorders10. Demonstrate clinical skills of neurodevelopment assessment, diagnosis and

management of peadiatric neurological conditions11. Apply ethical principle and professionalism in the management of children

with pediatric neurological conditions12. Describe and manage sensory disorders

7. Course Content outline Demonstrate ability to interpreted CNS disorders in childhood (etiology, pathophysiology,

examination, clinical presentation and management) Applied anatomy, embryology & Physiology

23

Neurophysiology Pathophysiology mechanism of CNS Congenital anomalies Movement disorder Seizures disorder Metabolic disorders Diagnosis Therapeutics Rehabilitation Neuromuscular disorders CNS infections Normal neurodevelopment CVS CNS Tumors Physical, emotional, social and environmental factors that influence neurodevelopment Pain recognition and management

References1. Epilepsies of Childhood 2nd Edition O’Donohoe2. Text book of Child Neurology 5th Edition Menkes

CODE: Nutrition and Gastroenterology1. Credit Units: 3.02. Year when Course is taught: Semester II, Years One3. Contact Hours: 454. Course Description

This course enables the students to learn about nutrition requirements in children, assessment of nutrition, as well as nutritional and gastrointestinal disorders in childhood.

5. AimTo equip students with the competences required to assess and promote adequate nutritional status in children; and manage children with nutritional and gastrointestinal, hepatic- biliary and pancreatic disorders

6. Course objectives / Expected outcomeBy the end of this course, the student should be able to:

1. Discuss normal nutrition requirements and their source2. Describe the principle of breastfeeding in health and in illness3. Demonstrate the ability to assess Nutritional status using approved

assessment tools4. Discuss various nutritional disorders and food-induced diseases5. To investigate nutritional and GIT disorders6. Apply the anatomy and physiology GIT and accessory gland7. Discuss Pediatric gastrointestinal disorders including : disease affecting the

oral cavity, he esophagus and stomach. Malabsorption syndrome, motility disorders and malformations.

8. Be able to manage and refer the newborn and the child with acute abdomen.

24

9. Diagnose and investigate the common problem of congenital and acquired liver disease, including viral hepatitis.

10. Apply the knowledge gained during the clinical management of patients. 11. Evidence based use of therapist agents in nutrition and GIT disorder12. Demonstrate the ability to health educate parents and community members to

prevention nutritional and GIT disorders13. Apply ethical principle and professionalism in the management of children

with pediatric neurological conditions

Course Content: Normal physiology of gastrointestinal system Normal nutritional requirements Nutritional assessment for children and adolescent in community and clinical setting Nutritional disorders Micronutrient deficiencies Breastfeeding and complementary feeding Community nutrition Supplementary feeding program Therapeutic feeding programs Nutritional response in emergency settings Malabsorptive disorders Gastrointestinal disorders in childhood Liver disorders of newborns and children Investigative procedures of G1 and nutritional disorders Monitoring and Evaluation of Nutrition Programs Multicentral Policies and strategies on childhood and community nutrition Attachment to Nutritional programs and Community

Course coordinator: Dr Nyeko RichardReferences

1. Human milk in the modern world 2nd Edition by Jelliffe and Jelliffe2. Human nutrition and Dietetics Davidson and Passmore 8th Edition3. Pediatrics Clinics Nutrition4. Helping mother Breastfeed Savage: King Amref

CODE: Nephrology1. Credit Units: 4.02. Year when Course is taught: Semester II, Years One3. Contact Hours: 604. Course Description

This course seeks to integrate the in-depth knowledge and skills in the area of kidney and urinary disease into the general care of childhood illness. Students will acquire and apply knowledge, skills and appropriate attitudes in recognition and management of kidney and urinary conditions in children, from conception to adolescence.

5. Aim

25

To equip the student with appropriate competences to assess and manage kidney and urinary tract disorders in children.

6. Course objectives / Expected outcomeBy the end of this course, the student will be able to:

1. Demonstrate knowledge in embryology, anatomy and physiology of the kidney and urinary tract

2. Identify common and uncommon congenital anomalies of kidney and urinary tract conditions

3. Describe kidney functions in children, both normal and abnormal states.4. Demonstrate skills in clinical exam, diagnosis and management of children

with kidney and urinary tract disorders5. Appreciate the need to prevent renal damage in clinical practice and the

complexity of managing chronic renal diseases in a resource poor environment.

6. Describe and interpret procedures used in investigating kidney and urinary tract conditions

7. Discuss feasible preventive strategies for kidney and urinary tract conditions8. Demonstrate skills and evidence based use of therapeutic agents in kidney

and urinary conditions9. The concept and the use of dialysis in management of renal disease10. Apply ethical principle and professionalism in the management of children

with kidney and urinary conditions

7. Course Content: Anatomy, embryology and physiology of kidney and urinary tract conditions Congenital anomalies of kidney and urinary tract Pathophysiology of renal diseases Clinical skills in the management of Urinary Tract Infections, including pyelonepritis Clinical skills in the management of a child with kidney and urinary tract conditions Diagnostic tests in kidney and urinary tract conditions Fluid and electrolytes balance Hypertension and the kidney Immunological and the kidney Metabolic disorders and the kidneys Recognize and manage acute kidney diseases : nephritis Recognize and treat chronic kidney disease : nephrotic syndrome Recognize and treat tubular disorders Prevention strategies for kidney and urinary tract damages Therapeutics Principles and use of dialysis Principles of kidney transplant

CODE: Health Systems Management 1. Credit Units: 4.0

26

2. Year when Course is taught: Recess Term, Years One3. Contact Hours: 604. Course Description

This course will address principles of planning, budgeting and overall management of health resources and facilities (e.g. hospitals), for effective and efficient delivery of health care.

5. Course objectives / Expected outcomesThe graduate students should be able to demonstrate the following competences:

1. Outline the health policy and system context of health care management in Uganda.2. Lead the process of preparation of strategic and operational plans for their organizations.3. Effectively work with and supervise other health workers, including the process of

continuing professional development4. Manage health systems to efficiently utilize scarce material resources for effective health

care delivery.5. Carry out basic health care finance planning, budgeting and management.6. Collect and use health information for management decision-making.

6. Course content Concepts in health policy, planning and management National health policy framework and the Health Sector Strategic Plan (HSSP) Organization of Uganda’s Health Care system Role of motivation and transformational Leadership in health service delivery Management of personnel in a health care organization Introduction to concepts in health economics and financial management Management of materials and logistics Information systems and basic performance indicators Medico-legal aspects of health care management

Course coordinator: Dr Aliku Twalib

CODE: Social and Community Paediatrics 1. Credit Units: 4.02. Year when Course is taught: Recess Term, Years One3. Contact Hours: 604. Course Description

This course will address students to community and child health. Students will discuss social determinants of child health, prevention of diseases in childhood, and promotion of child health. They will also participate in primary care activities.

5. Course objectives.By the end of this course, the student should be able to:

Discuss social determinants of child health. Understand and potentially modify the health determinants affecting patients and families in the

community that they serve. Apply primary care skills in managing common child hood diseases. Demonstrate appropriate professional behavior during the provision of primary care.

27

Provide culturally-competent, family-centered, coordinated and community-based care utilizing community strengths and assets

Explore how socio-economic factors and poverty affect child and adolescent health.

6. Course objectives / Expected outcomesBy the end of the course, the student should demonstrate the following competencies:

Application of knowledge of child health Communication and interpersonal skills. Leadership and management skills. Promotion of child health, and prevention of disease. Critical iniquity. Self directed learning

7. Course content Child health and development Determinants of child health. Prevention of common child hood illnesses. Integrated management of child hood illnesses. Prevention of malnutrition Child survival Community participation

8. Course coordinator: Dr Byaruhanga Charles

References1. Primary Health Care: A manual for medical students and other health workers 3rd Edition

by Kapano Mukelabai2. Maternal and Child Health in practice: Training module for middle level workers by G.J

Ebrahim, A.M Ahmed, A.A Khan

YEAR TWOCODE: Neonatology

1. Credit Units: 4.02. Year when Course is taught: Semester I, Year Two3. Contact Hours: 604. Course Description

This course addresses the special health needs of newborn infants both in the community and the hospital environment from the prenatal, through the birth and the postnatal periods

5. AimTo equip the student with the appropriate competences to care for normal as well as sick newborn infants. Handle resuscitation emergencies effectively

6. Course objectives / Expected outcomeBy the end of this course, the student should be able to:

1. Discuss the care of new born infants28

2. Discuss abnormal condition in new born infants3. Demonstrate the ability to access and manage normal as well as sick new

born infants.4. Demonstrate an in-depth understanding of fetal-neonatal physiology and

pathophysiology of more complex neonatal disorders and utilize this information in the management of neonatal infants.

5. Demonstrate skills for effective resuscitation of a newborn6. Describe and perform procedures used in investigating prenatal and newborn

infant condition7. Request and interpret laboratory and imaging investigations and formulate sound

diagnostic impression that is specific to the clinical problem encountered during neonatal care.

8. Demonstrate skills and evidence based use of therapeutic agents in the management of neonatal conditions

9. Demonstrate respectful and considerate attitudes; effectively communicate with families, and other health care personnel, when addressing management plans, patient issues, and especially end-of-life decisions of neonates.

10. Provide timely, legible, and thorough medical record documentation - histories and physical examinations, admission notes, progress notes, procedure notes and discharge summaries during neonatal care.

11. Apply ethical principle and professionalism in the management of newborn conditions

7. Course Content: Introduction to neonatal epidemiology, vital statistics General principles of physiology and care of a new born Identification of prematurity and immaturity (AGA and SGA LBW neonates) Problems in the newborn period (causes, pathophysiology, clinical presentation, and

management) Prevention of perinatal morbidity and mortality, with special attention to congenital

and acquired infections Skills in management of preterm and post term infant Principles and skills of neonatal resuscitation Identify and management neonatal congenital anomalies Evidence based therapeutic for preventive and management of neonatal condition Diagnostic tests in the management of prenatal and neonatal conditions Perinatal death audits Neonatal feeding Inter-personal skills and medical ethics

13. References1. Disease of the New Born Child by Talusch, Ballard, Avery (Schaffer and Avery’s) 2. Text book of Neonatology 3rd Edition Robertson Renurie 3. Care of the New Born by Richard L. Schreiner, Nicetta C. Bradburn4. The practice of Pediatrics Neunatology by Swaiman and Wright

29

CODE Child and Adolescent Mental Health

1. Credit Units: 4.02. Year when Course is taught: Semester I, Years Two3. Contact Hours: 604. Course Description

In this course, the students will learn about the presentation and management of common psychological, psychiatric and behavioral disorders in children and adolescents

5. AimTo equip students with competences required to manage, psychological and psychiatric disorders in childhood.

6. Course Objectives / Expected outcomeBy the end of this course, the student will be able to:

Demonstrate skills in clinical exam, diagnosis and management of children and adolescent with mental and behavioral disorders.

Describe and interpret procedures used in investigation of children and adolescent with mental and behavior disorders

Apply the knowledge gained in the clinical management of children and adolescent in mental and behavioral disorder

Etiology and pathophysiology of common childhood mental and behavioral disorders Describe and interpret procedures used in investigating children and adolescent with

mental health disorders Demonstrate skills and evidence based use of therapeutic agents in the management of

mental health conditions in children and adolescents Apply ethical principle and professionalism in the management of mental health

disorders in children and adolescents Demonstrate skills in diagnosing learning and behavioral disorder

7. Course content outlineo Assessment and classification of mental health conditionso Psychological Therapies in Child and Adolescent Psychiatryo Psychiatric and psychological assessment toolso Mental health and the community o Preventiono Ethics & professionalismo Therapeticso Psychiatric emergencieso Substance abuseo Medical legal aspects of child and adolescent mental health o Behavior and conduct disorders o Learning disordero Child abuse, neglect and the familyo Role of alternative mental health provider (Religious, tradional healers etc)

30

8. Course coordinator:Prof. Emilo Ovuga

CODE: Epidemiology, Biostatistics and Research Methodology 1. Credit Units: 5.02. Year when Course is taught: Semester II, Years One3. Contact Hours: 754. Course Description

This course is intended to equip students with knowledge and skills in the conduct and analysis of research studies, and in evidence synthesis as applied to healthcare.

5. Course aimsTo equip students with knowledge about the principles and methods of Epidemiology, Biostatistics and Research. The course also will equip students with skills of application of Epidemiology, Biostatistics and Research methods to health as well as skills of research proposal development and scientific writing.

6. Course Objectives/Expected OutcomesAt the end of the course student will be able to: Apply principles and practice of epidemiology and research methodology as applied to

science and healthcare. Be able to collect data in a concise and reliable way, ready for statistical analysis Apply the statistical methods used in analysis of clinical and population based studies. Critically appraise published reports and papers in the field of healthcare in order to generate

credible evidence in healthcare. Conceptualize and develop a research concept paper and a proposal.

7. Course Content Outline Introduction, definition and uses of epidemiology Basic epidemiological principles and methods and epidemic investigation Ratios, proportions and rates Natural history of disease, screening, and prevention Measuring health and disease (morbidity, mortality, standardization, vital statistics,

surveillance) Mortality measures (CFR, crude death rate, infant mortality rate and MMR) Validity (sensitivity and specificity, positive and negative predictive values) and Reliability

(inter-observer and intra-observer variation, Kappa statistics, Percent agreement) of diagnostic and screening tests

Epidemiological study designs (descriptive epidemiology, analytical epidemiology and interventional epidemiology)

Measures of association (absolute risk, rate/ratio/relative risk, odds ratio, attributable risk) Cause and effect relationship (necessary and sufficiency) Causal inference (criteria for causality) Assessing the relationship between variables Efficacy and effectiveness of interventions Validity of epidemiological research

31

Epidemiology and public health policy Ethical and professional issues in epidemiology Introductory concepts in biostatistics Different types of scales of measurements Data summary measures (measures of central tendency, measures of dispersion, etc), and

data presentation methods (tabular and graphical) Definition of population, target population, study population, and sample. Sample selection using simple random sampling, systematic, cluster sampling, stratified

sampling, multi-stage sampling, etc. Sample size determination for cross-sectional, case-control, and cohort studies. Data analysis using computer application SPSS or SAS

8. Course coordinator: Dr Nyeko Richard9. References 1. Epidemiology by Leon Gordis2. Introduction to Biostatistics by Daniel

Clinical Methods and Emergency Paediatrics III

1. Credit Units: 4.02. Year when Course is taught: Semester II, Years Two3. Contact Hours: 604. Course Description

In this course, the students will practice the clinical skills of assessing and managing children with childhood diseases and illnesses, including emergencies.

5. Aim To provide the students with opportunity to practice and improve their competency in the strategic management of sick children.

6. Course objectives / Expected outcomesBy the end of this course, the student should be able to:

1. Effectively handle Pediatric problems including emergencies without supervision.2. Manage life threatening conditions in childhood and adolescents without supervision.3. Take a focused history, physical examination and investigation of a children's conditions4. Teach and mentor medical students, nurses and juniors these skills5. Use skills and evidence based therapeutic agents in managing paediatric patients6. Apply ethical principle and professionalism in the management of paediatric patients7. Course content:

Advanced Paediatric Life Support skills Identify and refer pediatric patients to sub-specialty Apply advanced skills in managing pediatric emergencies Diagnose and manage Common Paediatric problems without supervision Effectively manage chronic and system disorders in children Judicially recommend, conduct and interpret investigations for specific

investigations Use all available Therapeutic

32

Ethics and Professionalism Manage Emergency and none emergency paediatric conditions

8. Course coordinator:Dr Ruth Lanyero

CODE: Cardiology 1. Credit Units: 3.02. Year when Course is taught: Semester II, Years Two3. Contact Hours: 604. Course Description

In this course, the students will learn about the presentation and management of common cardiac disorders in neonates, children and adolescents.

5. Course AimTo equip students with competences required to assess, diagnose and manage common cardiovascular disorders neonates, children and adolescents

6. Course Objectives / Expected outcomeBy the end of this course, the student will be able to:

1) Demonstrate knowledge in embryology, anatomy and physiology of the cardiovascular system (CVS)

2) Describe etiology and natural history of different CVS disorders3) Identify congenital anomalies of the CVS4) Describe cardiac functions in healthy and diseased hearts.5) Demonstrate skills in history taking, physical examination, diagnosis and management of

children with cardiac conditions 6) Develop strategies for prevention cardiovascular diseases diseases in children7) Describe and interpret procedures used in investigating CVS disorders8) Demonstrate skills and evidence based use of therapeutic agents in managing CVS

conditions9) Apply ethical principle and professionalism in the management of children with heart

disease10) Describe recent advances and their application in the management of CVS conditions

33

7. Course content outline Anatomy, embryology and physiology of CVS. Fetal and New born circulations. Aetiology of different acquired and congenital heart diseases Pathophysiology of CVS conditions Assessment and management of a newborn with severe respiratory distress and cyanosis Assessment and management of the newborn, infant and child with cardiogenic shock Assessment and management of the newborn, infant and child with congestive heart

failure Cyanotic and acyanotic Congenital anomalies of the heart Autoimmune inflammatory and infectious diseases affecting the heart and blood vessels. Systemic diseases with cardiovascular manifestations Diagnostic tests in evaluating the functions of the CVS Assessment and management of childhood Hypertension Primary, secondary and tertiary prevention strategies for cardiovascular disorders The role of genetic counseling and family screening in specific cardiovascular diseases in

children

10. Course coordinator:Dr Twalib Aliku

11. References1. Heart Disease in Pediatrics 3rd Edition by Bulter Worths2. Atlas of Pediatrics Pyhisical Diagnosis 4th Edition by David Zittelli

CODE: Internal Medicine1. Credit Units: 4.02. Year when Course is taught: Semester II, Years Two3. Contact Hours: 604. Course Description

This course will let the learner appreciate the growing menace from NCDs as a global challenge to health (80% of the global burden being born by the developing countries). Emphasis will be laid on efforts to combat its onslaught right through the life cycle( from conception to old age).

5. Course aimsTo equip the student with the competences required to manage and prevent NCDs at the primary, secondary and tertiary levels by the adoption of appropriate interventions.

6. Course Objectives / Learning outcomeFocus will be on chronic cardiovascular diseases, cancers, respiratory diseases, kidney diseases and diabetes. By the end of this course the student should be able to:

Understand the importance of the early days in conditioning the risk of NCD Advocate for multisectoral approaches to prevent NCDs Apply the chronic care model for management of NCDs Apply measures for follow-up of NCD subjects? To demonstrate the ability to manage NCDs To help devise measures to prevent NCDs progression and complications

34

To promote measures for rehabilitation

7. Course Content outlineThe spectrum of NCDs drivers of the NCDs epidemic, the epidemiologic transition, the role of infectious agents, management of specific NCDs- Understand the effect of prenatal and post natal factors in conditioning the genetic risk associated to the development of NCD (epigenetic factors)- analyze the effect of early growth velocity on the future risk of Cardio Vascular Disease- relate the early obesity to the risk of NCD in adulthood- understand the evolution in the adult age of chronic diseases in infancy and childhood- manage the transmission of adolescent diseases to the adult physician

CODE: Oncology and Hematology1. Credit Units: 4.02. Year when Course is taught: Recess, Years Two3. Contact Hour: 604. Course Description Course name:  Paediatric Haematology and Oncology

Course code:  PCH6411

Course descriptionHaematological problems, particularly anaemia, are very common and contribute significantly to child morbidity and mortality in Uganda. Some causes such as malaria and iron deficiencyare major public health problems, with global control programs.Oncology is usually considered a highly specialized field in medicine. However, for the most part, the general paediatrician carries the responsibility of suspecting and recognizing the child with a possible diagnosis of cancer and, initiating the investigations and managing complications. Malignancies and particularly haematological malignancies have high impact on childhood mortality being one of the most important causes of mortality and morbidity among childrenbetween 5 and 14 years of age even in developing countries. This is due mainly to very high prevalence of Burkitt’s Lymphoma in East Africa and particularly in Uganda.

5. The student will, therefore, be expected to gain reasonable competence in the diagnosis and treatment of some of the more common childhood cancers, to gain reasonable knowledge of the most used anticancer drugs and their side-effects, to be capable to recognize and treat the most common complications and emergencies in oncology.

Course objectives

Be able to recognize the clinical features of the different types of anaemia in infants and

35

children, To understand the causes and mechanisms of anaemia and identify the commoner causesTo be able to initiate and supervise the rational investigation of a child presenting with anaemia.Be able to appropriately manage the long-term treatment of anaemia in childrenBe able to select the child who needs transfusion, and to use blood appropriately and safely Be able to manage the child with sickle cell disease both in crisis and in the steady stateBe able to manage most common complication in SCDBe able to recognize when bleeding is abnormal, and features which suggest serious pathologyBe able to recognize the features of thrombocytopenia and coagulopathyBe able to request appropriate investigations in a child presenting with bleeding

6. Be able to urgently resuscitate and manage a child who presents with active excessive bleedingBe able to initiate and supervise the long-term management of a child with ITPBe able to recognize clinical situations that could lead to neutropeniaRecognize the dangers and the features of polycythaemiaBe aware of the public health importance of childhood leukaemiaBe able to recognize the clinical manifestations of leukaemia in children, require investigations and using appropriate diagnostic and treatment international protocols.Be able to recognize the clinical presentations of Burkitt?s lymphoma and other lymphomas in children, require investigations and start first line of treatment.Be able to prepare the child with BL for chemotherapy, be aware of possible adverse effects of chemotherapy, and to safely carry out the treatment of a child with BLBe able to recognize the clinical presentations of the common solid tumours in childhood, require investigation and refer to specialist for treatment.

Course ContentThe definition, causes and classification of anaemia, Common nutritional deficiency anaemias (esp. iron deficiency)Common haemolytic disorders (hereditary disorders ? the sickle cell diseases, thalassemias, red cell membrane disorders, red cell enzyme deficiencies, immune haemolysis and others)Bone marrow suppressionBlood transfusionAbnormal bleedingPurpura and bruising (thrombocytopenia and other platelet disorders, vasculitis)Important coagulopathies in children (haemorrhagic disease of the newborn, hereditary coagulation disorders e.g. haemophilia, and acquired disordersTypes and causes/risk factors of neutropenia, Febrile neutropeniaPolycythaemia in the newborn and the childTypes of leukaemia, Clinical manifestations, Acute lympholastic leukaemia, Acute

36

myeloblastic leukaemiaBurkitt’s lymphomas and Other non-Hodgkin’s lymphomasHodgkin’s diseaseOther common solid tumours in children : Nephroblastoma, Neuroblastoma, RetinoblastomaCentral Nervous system tumorsCommon emergencies in pediatric oncology/hematologyAbdominal MassesBlood and Blood Product Transfusions

Procedures

Pleural tap, Bone marrow aspirate and biopsy, Fine needle aspiration cytology

Textbooks

Frenbach and Vietti. Clinical Paediatric Oncology. Mosby Textbook of Paediatric HematologyP. Solalceligny and N. Brousse. Non-Hodgkin?s Lymphomas. Manson PublishingSlovis. Caffey?s Paediatric Diagnostic Imaging. Volumes 1 & 2. Mosby.

Course coordinator:Dr. Valeria Calbi

Resources and Infrastructure available Uganda Cancer Institute St. Mary’ Hospital Lacor

YEAR 3CODE: Clinical Methods and Emergency Paediatrcs IV

1. Credit Units: 4.02. Year when Course is taught: Semester 1, Years Three3. Contact Hours: 604. Course Description

In this course, the students will practice advanced clinical skills of assessing and managing children with childhood conditions and emergencies.

5. Aim To provide the students with opportunity to practice and improve their competency in the management of sick children.

6. Course object / Expected outcomeBy the end of this course, the student should be able to:i. Demonstrate the ability to independently handle common Pediatric problems and

emergencies.ii. Demonstrate advanced competency in the management life threatening conditions

37

iii. Demonstrate the ability to take a focused history, physical examination and investigation of a child's problem

iv. Demonstrate advanced skills in teaching and mentoring junior’s health professionalsv. Demonstrate skills and evidence based use of therapeutic agents in managing paediatric

patientsvi. Apply ethical principle and professionalism in the management of paediatric patients

7. Course content: Advanced Paediatric Life Support skills Apply advanced skills in managing paediatric sub-specialty clinic Apply advanced skills in managing pediatric emergencies Acquire Skills in pediatric mini-invasive procedures Team buiding skills. Effectively manage chronic and system disorders in children Analytic thinking, recommending, performing and interpreting investigations

results Evidence base use of therapeutic agents in clinical setting Ethics and Professionalism Emergency and none emergency Paediatric conditions Effective interpersonal relationship Appropriate leadership skills

References1. Clinical Methods by Hutchisons

CODE: Pulmonology1. Credit Units: 4.02. Year when Course is taught: Semester I, Years Three3. Contact Hours: 604. Course Description

This course covers the normal functioning and pathophysiology of the respiratory system . It covers diseases of the lungs, bronchi and pleura and their management. The relationship between cardiac and pulmonary disease is elaborated.

5. .Aim To equip the students with skills and knowledge of managing disease of larygotracheobrochial tree and lung parenchyma.

6. Course objectives / Expected outcomeAt the end of this course students should be able to: Demonstrate knowledge and applied anatomy, histology and physiology of the

respiratory system To demonstrate skills in focused history taking, examination, investigations and

management of respiratory conditions Describe the pathophysiology of respiratory system Identify etiological factors in pulmonary conditions Identify presenting features in respiratory disorders in children and adolescents

38

Ability to assess lung functions Identify, carryout and interpret the results of specific investigations results in the

assessment of respiratory function Demonstrate knowledge in the assessment and management of acute and chronic disease

of the respiratory tract such as asthma, bronchiectasis Demonstrate knowledge on the effect of environmental pollution on respiratory system Evidence basic therapeutics Ethics and professional conduct in care for children with chronic respiratory disease

7. Course Content: Anatomy, embryology, histology and physiology of RS Congenital anomalies of RS and the diaphragm Pathophysiology of RS conditions , acid-base haemo-gas analysis Clinical skills in the management of a child with RS conditions Identify, carry out and interpret the results of radiological investigations Diagnostic tests in evaluating the functions of the RS Etiology of Respiratory System disorders. Assessment and management of respiratory

emergencies such as acute asthma, upper airway obstruction, pneumothorax/pleural effusions, respiratory failure

Cardio-pulmonary related diseases such as cor pulmonale Prevention of respiratory diseases Environment and respiratory disorders Evidence based use of therapeutic agents in the management of pulmonary conditions Ethics

Course coordinator:Dr Ruth Lanyero

CODE: Endocrine and Metabolic Disorders1. Credit Units: 4.02. Year when Course is taught: Semester I, Years Three3. Contact Hours: 604. Course Description

In this course, the students will learn about endocrine and metabolic disorders in childhood.

5. AimTo equip the students with the appropriate knowledge and skills required to manage endocrine and metabolic disorders in childhood and adolescence.

6. Course objectives / Expected outcomeBy the end of this course, the student should be able to:

Demonstrate knowledge and applied anatomy, embryology histology and physiology of the endocrine and metabolic system

To demonstrate skills in focus history taking, examination, investigations and management of endocrine and metabolic disorders in children and adolescent

Describe the pathophysiology of diabetic mellitus Synthesis, secretion, control and functions of hormones

39

Identify etiological factors in endocrine and metabolic disorders Clinical presenting of endocrine and metabolic disorders in children and adolescents Identify relevant investigations, perform and interpret the results. Demonstrate knowledge on the action on endocrine and metabolic therapeutics agents Apply ethical principle and professionalism in the management of paediatric patients Demonstrate skills for counselling of children and their parents on endocrine and

metabolic disorder

7. Course contents Applied anatomy, embryology, histology and physiology of endocrine gland Etiologic factors in endocrine and metabolic conditions in children and adolescent Assessment and management of a child with diabetic mellitus Assessment and management of a child with hypothyroidism and adrenal insufficiency Clinical presentation and management of other endocrine and metabolic disorders Identify, perform and interpret relevant investigation Evidence based use of therapeutic agents Principles of hormonal replacement therapy Counseling and communication skills to children and their care takers Ethical principles and professionalism in the management of endocrine and metabolic

disorder

8. Course coordinator:Dr Ruth Lanyero

References1. William’s Text books of Endocrimology 10th Edition Larsen, Kuronenberg, Polonsky2. Smith’s Recognizable patterns of Human malformation by Jones 4th ed

CODE: Emerging & re-emerging disease

1. Credit Units: 2.02. Year when Course is taught: Semester I, Years Three3. Contact Hours: 304. Course Description

In this course, the students will learn the principles of emerging and re-emerging diseases in children and adolescent. Acquire an in-depth understanding of common immunological, allergic and infectious diseases in childhood.

5. AimsTo equip the students with knowledge and skill to identify, investigate and mange emerging and re-emerging diseases in children and adolescents.

6. Course Objectives / Expected outcomeBy the end of this course, the student will be able to:

1. To demonstrate the ability to identify emerging and re-emerging disease2. Determine etiologic factors that governed emerging and re-emerging diseases.

40

3. Understand the protocol for investigating and managing children and adolescents with emerging and re-emerging conditions

4. Protocols for preventing epidemics of emerging and re-emerging conditions5. To demonstrate appropriate ethical and professional contact in the management of this

patient6. Understand the principle of vaccine development

7. Course Content outline Identify Ebola, SARS, Marburg, swine fever, etc Global collaboration Global infection prevention programs and measures Counseling skills for patients and relatives Vaccine development and immunization

CODE: Clinical Methods and Emergency Paediatrcs V

1. Credit Units: 4.02. Year when Course is taught: Semester II, Years Three3. Contact Hours: 604. Course Description

In this course, the students will practice the clinical skills of assessing and managing children with childhood diseases and illnesses, including emergencies.

5. Aim To provide the students with opportunity to practice and improve their competency in the management of sick children.

6. Course objectives / Expected outcomeBy the end of this course, the student should be able to:

Demonstrate the ability to handle common Paediatric problems including emergencies. Demonstrate the ability to manage life threatening conditions in childhood. Demonstrate the ability to take a focused history, physical examination and investigation

of a child's problem

7. Course content: Full responsibility for : Advanced Paediatric Life Support Paediatric emergences Common Paediatric problems in childhood. Chronic and system disorders in children

CODE: Paediatrics and Child Health Policy

1. Credit Units: 3.02. Year when Course is taught: Semester II, Years Three3. Contact Hour: 454. Course Description

41

This course enables students to understand National and International child health policies, and to discuss the cause, presentation, management and prevention of various diseases and conditions in childhood.

5. AimTo equip the students with an in depth understanding of National and International child health policies, childhood diseases and apply this knowledge in the clinical management of sick children, and promotion of child health through effective advocacy for children.

6. Course objectives / Expected outcomeBy the end of this course, the student should be able to: 1. To discuss the National and International child health policies2. Demonstrate competence in management of various childhood diseases and conditions.3. Advocate for child promoting and protection policies4. Understand and promote the right of infants, children and adolescent

7. Course Content outlineNational and International child health policiesMillennium development goals and post millennium development goals agendaChild survival strategiesImportant National child health statistics such as neonatal, infant and under five mortality ratesNational immunization programs and immunizable diseases PMTCT and EMTCT of HIVChild hood diseases and disordersChild Health and the Law: UN convention on the rights of childrenAdvocacy for children’s rights

CODE: Research Dissertation1. Credit Units: 5.02. Year when Course is taught: Semester II, Years Three3. Contact Hours: 754. Course Description

The course will enable student gain knowledge, skills and attitudes on how to carry research, analyze results, write a report and disseminate the findings within given timeframe.

5. AimTo equip the students with the knowledge and skills of carrying out scientific research, defend their research findings and disseminate the information to stake holders.

6. Course objectives Able to carry out scientific research Allow students to make original contribution to knowledge and practice in the area of

their investigations. To critically evaluate and assimilate published works and research and background

material appropriate for their chosen area of study. Apply scientific writing skills Collect data in a concise and usable manner Analyse and present research findings in a scientific and logical manner Exhibit critical thinking when drawing conclusions of research findings Plan the appropriate modes of disseminating the research findings

42

Write and submit a manuscript for publication

7. Course Content:Implementation of research proposalAnalyzes of the data and make rationale conclusion and recommendationWrite up of the data with the supervisor’s inputDissemination of report to relevant stakeholdersMethods of instructions Self-directed learningSupervisors’ guidanceAssessment methodAssessment will be by marking the dissertation, and conducting a viva voce oral examination.Dissertation should contain: (a) A clear introduction showing the objectives of the study; (b) A rationale for the area of study and the research approach adopted; (c) A discussion of the issues involved, related to published works; (d) Appropriate investigative procedures and methods of handling the data; (e) A methodology for dealing with the issues and discussion of these issues; (f) A conclusion with possible recommendation; (g) Appropriate organization of material including graphical/diagrammatic displays as required and the referencing of sources, including a Reference section.

Course Coordinator: Dr Byaruhanga

ReferencesEpidemiology and Research Methodology references/Biostatistics (ER 600) Statistics at square one, British Medical Journal. online

43