Childrens Health Discipline Guide

Academic and Administrative Staff – Monash Medical Centre
Academic Teaching Administration

Medical Staff
Professor Nick Freezer Mrs Lia Bretag

Professor and Director of Paediatrics Undergraduate Administrator
Head, Department of Paediatrics Southern Clinical Teaching Programs Office
Telephone: 9594 7645
Professor Wei Cheng Email: angelina.bretag@monash.edu
Head, Paediatric Surgery
Associate Professor Michael Fahey Contact via administration staff
Dr Justin Brown
Senior Lecturer
Dr Rupert Hinds
Lecturer
Academic Staff - Metropolitan Sites
Eastern Health Clinical School

(Box Hill, Maroondah and Angliss Hospitals)
http://www.med.monash.edu.au/ehcs/
Site Coordinator Site Administration

L2, 5 Arnold Street, Box Hill Dr Anthony Chin
Box Hill Hospital

Nelson Road, Dr Bill Capell Ms Bianca Whelan
Box Hill bianca.whelan@monash.edu
Maroondah Hospital

Davey Drive, Christine Harewood
Ringwood East christine.harewood@monash.edu
Telephone: 9955-1166
Angliss Hospital

Albert Street, Tanya Agius
Upper Ferntree Gully Tanya.agius@monash.edu
Copyright © Monash University 2011. All rights reserved. Except as provided in the Copyright Act 1968, this work may not be
reproduced in any form without the written permission of the host Faculty and School/Department.
1
Academic Staff - Metropolitan Sites
Cabrini Hospital
http://www.med.monash.edu.au/locations/hospitals/

183 Wattletree Road Dr Simon Costello
Malvern Telephone: 9509 8688
• Students should meet Dr Simon Costello in the Children’s Centre on the 1st floor in the meeting room
at 8:45am. He will give you a tour of the facilities followed by orientation to the operating theatre.
• Car parking is available off-street, 2 blocks (5 min walk) south of the hospital (free of parking
restrictions)
• Trams stop at the hospital in Wattletree Road and the nearest train station is Malvern (5 min walk)
Dandenong Hospital

David Street, A/Prof Rosengarten Ms Gina van de Berg
Dandenong Telephone: 9791 4344 gina.vandeberg@monash.edu
Telephone: 9554-1000 Telephone: 9554 8195
• Dandenong and Casey students are to meet Associate Professor Rosengarten in his rooms located
at 122 David Street, Dandenong at 9:00am sharp of the first day of rotation
• The Clinical Site Administrator will meet you at the main entrance of the hospital at 9:30am
• Please note that there is no accommodation available and no designated parking for medical
students. There is all day parking in some of the streets surrounding Dandenong Hospital such as
Bruce St, David St and Cleeland St.
• Information regarding public transport can be found at www.metlinkmelbourne.com.au. There is a
community bus that runs between Dandenong station and the hospital. This service is free of charge.
Lockers are located in the Medical School Common Room, please bring your own padlock.
• Casey students should travel from Dandenong at the conclusion of Orientation with A/Prof
Rosengarten to Casey Hospital and meet with Melissa Edwards at 10:15am for a brief site
orientation. Students will then meet Datta Joshi to commence their rotation. Further details will be
sent to students prior to their commencement date.
Casey Hospital

62-70 Kangan Drive, Berwick Dr Bruce Jackson Mrs Melissa Edwards
Telephone: 8768 1200 Telephone: 8768 1487 melissa.edwards@monash.edu
2
Academic and Administrative Staff – Regional Sites
Gippsland Regional Clinical School

(Warragul Hospital, Latrobe Regional Hospital & South Gippsland)
http://www.med.monash.edu.au/med/srh/gippsland/index.html

West Gippsland Paediatric Group Dr Joseph Tam Mrs Judy Lawless
7 Sargeant Street, Warragul joseph.tam@monash.edu judy.lawless@monash.edu
Telephone: (03) 5622 1500 Telephone: (03) 5173 8616 Telephone: (03) 5122 7233
Latrobe Regional Hospital Dr Joseph Tam Mrs Judy Lawless
Traralgon West joseph.tam@monash.edu judy.lawless@monash.edu
Warragul Hospital Dr Joseph Tam Asra Bachaz
Ley Street, Warragul joseph.tam@monash.edu asra.bechaz@monash.edu
• At least two weeks before the start of semester, all students are to contact our Year 4 C/Clinical Site
Administrator Ms Judy Lawless via email judy.lawless@monash.edu or telephone 03 5122 7233.
Please direct all enquiries including accommodation through Judy in the first instance.
East Gippsland Regional Clinical School

(Bairnsdale & Sale)
http://www.med.monash.edu.au/med/srh/eastgippsland/index.html

A/Prof David Campbell Mrs Margaret Connolly
Bairnsdale david.campbell@monash.edu marnie.connolly@monash.edu
Telephone: (03) 5150 3620 Telephone: (03) 5150 3615
Site Administration
A/Prof David Campbell Ms Loy Perryman
Sale david.campbell@monash.edu loy.perryman@monash.edu
Telephone: (03) 5150 3620 Telephone: (03) 5143 8505
Peninsula Clinical School

(Frankston Hospital, Peninsula Health)
http://www.med.monash.edu.au/peninsula/

Frankston Hospital Dr Patrick Fiddes Kath Creme
2 Hastings Road, Frankston pfiddes@phcn.vic.gov.au kcreme@phcn.vic.gov.au
Telephone: 9784 7777 Telephone: 9784 7883
3
Bendigo Regional Clinical School
http://www.med.monash.edu.au/med/srh/bendigo/index.html

37 Rowan Street Geoff Solarsh Ms Lyndsey Brown
Bendigo geoff.solarsh@monash.edu lyndsey.brown@monash.edu
• Pauline Blake will be your contact for accommodation arrangements in Bendigo. Email
pauline.blake@monash.edu or phone 03 5440 9054. Accommodation may be at Lister House of at
student housing. You will need to ring Pauline with your contact details four weeks before arrival in
Bendigo.
Mildura Regional Clinical School

http://www.med.monash.edu.au/med/srh/mildura/index.html

231-237 Thirteenth Street, A/Prof Fiona Wright Mr Mark Heald
Mildura fiona.wright@monash.edu mark.heald@monash.edu
• Ros Hocking is the contact person for accommodation in Mildura, and you will normally be living in
rental houses in the community, close to the clinical school and Mildura Base Hospital. A bicycle is
provided at each house for those who do not have their own car. Contact Ros via email
ros.hocking@monash.edu or telephone 03 5022 5500. For matters relating to timetabling and
administration in Mildura contact Desley Reid-Orr via email Desley.reid-orr@monash.edu or
telephone 03 5022 5536
Clinical School Johor Bahru

Malaysia
http://www.med.monash.edu.my/jcsmhs-in-monash/Clinical-School-Johor-Bahru.html

Dr Ngim Chin Fang Sister Faridah Abu Bakar
Head of Paediatrics Faridah.bakar@monash.edu
Ngim.chin.fang@monash.edu Sister Asmah Siran
Telephone: 0011 60 721 90624 Asmah.siran@monash.edu
4
IMPORTANT DATES 2013
Children’s Health Semester 1
SEMESTER 1, 2013 DATES
Workshop Week Lecture Program (Week 1)

All Monash & Metro Rotation 1.1 & 1.2 11 February – 15 February
Children’s Health Students to attend
Rotation 1.1 (Week 2 – 5) 18 February – 15 March
Rotation 1.2 (Week 6 – 9) 18 March – 12 April

All Monash & Metro Rotation 1.3 & 1.4 15 April – 19 April
Rotation 1.3 (Week 11 – 14) 22 April – 17 May
Children’s Health Contemporary Issues – Group Presentations 15 March
Rotation 1.4 (Week 15 – 18) 20 May – 14 June
Children’s Health Semester 2

SEMESTER 2, 2013 DATES
Workshop Week Lecture Program (Week 1) 8 July – 12 July

All Monash & Metro Rotation 2.1 & 2.2
Rotation 2.1 (Week 2 – 5) 15 July – 9 August
Rotation 2.2 (Week 6 – 9) 12 August – 6 September

All Monash & Metro Rotation 2.3 & 2.4 9 September – 13 September
Rotation 2.3 (Week 11 – 14) 16 September – 11 October
Children’s Health Contemporary Issues – Group Presentations 9 August
Rotation 2.4 (Week 15 – 18) 14 October – 8 November
END OF YEAR EXAMS

Dates for OSCEs and Written exam papers will be advised.
5
ACADEMIC OVERVIEW
Learning Objectives
Paediatrics is different from other clinical disciplines as it provides care to children of all ages and
different stages of physical and emotional development. Whilst this is quite novel for most
students, it is not really unfamiliar to you and even brief reflection will remind you of material
discussed earlier in your course in which a developmental dimension was important.
The Children’s Health rotation is a quarter of the Year 4 Program and has important links to the
activities you will undertake throughout the remainder of the year. We hope that you will enjoy this
rotation more than any other in the course and that you will find that your efforts are rewarded with
rapidly growing confidence, skill and proficiency in this important discipline.
We would like you to be very active in the clinical setting. You should take every opportunity to
clerk patients (i.e., act as the first point of contact for their encounter), establishing that the medical
staff are aware of your actions and providing appropriate supervision, including signing any entries
you make into the patient clinical record. You will be rostered to attend a wide variety of clinical
activities, ranging from community based clinics to tertiary level outpatient consulting sessions and
you should spend as much time as possible visiting children in hospital wards to practice history
taking and examination.
You should present these patients formally in teaching sessions and on ward rounds. At the same
time you should be reading an appropriate textbook to study your way through the core curriculum,
and you should also take every opportunity to read about specific conditions you encounter in your
clinical activities.
Because we recognise that clinical experience helps cement the knowledge achieved through
study, the Directed Activities form a bridge between book learning and clinical experience, with a
“live patient” PBL or PCL. Use the Directed Activities wisely as they form the basis for many
OSCE’s/
COURSE OUTLINE
Women’s & Children’s Health will share one semester of eighteen weeks. This comprises nine
weeks Women’s Health and nine weeks Children’s Health. The Children’s Workshop occurs in
week 1 of each 9 week term of Semester 1 and Semester 2.
Undergraduate students will rotate between metropolitan hospitals and Monash Children’s at
Monash Medical Centre. The metropolitan hospitals are The Angliss, Box Hill, Dandenong, Casey,
Frankston and Cabrini Hospitals. Students will attend one of these sites for four weeks and
rotate to MMC for four weeks clinical experience. Some students will be at MMC for 8
weeks.
Post graduate students at the Gippsland campuses will complete a 12 month program of
integrated clinical immersion which will cover Women’s & Children’s Health, Psychological
Medicine and General Practice.
Your Children’s Health rotation builds on the skills learned during Med 3. You will be using a
clinical clerkship model for learning. This means that you should use problem based learning
techniques to learn from the children you see on the wards, in the Emergency Dept, in outpatients
and in clinician’s rooms.
During your rotation, you must improve your history taking and clinical examination skills whilst
identifying key learning objectives from the clinical cases you see. To assist you further we have
developed approximately 45 “Directed Activities” to indicate the breadth of paediatric conditions
with which you should be familiar.
6
Theme 1 and 2 content is embedded into the core Children’s Health (CH) curriculum and will be
evident in many of your clinical encounters during the term. Health Systems and Management
(Semester 1), Health Economics (Semester 2) and Evidence Based Clinical Practice (EBCP) are
Moodle based and will need to be completed during your Women’s and Children’s Health
Semester. Please ensure that you allow approximately 2-3 hrs each week for these tasks to be
completed before the end of the semester.
Medical Law and Ethics has also been integrated into the curriculum and you should contemplate
these aspects of clinical care throughout your paediatric rotation. There are some formal tutorial
based discussions on key topics during the Workshop Week (MMC/Metro) to further assist your
learning in these areas.
The main activities during your Children’s Health rotation are:
• Clinical clerkship
• Bedside tutorials
• Directed activities
• Case based tutorials
• Workshops/tutorials of some key topics
• Allied heath & community visits
• EBCP & Health systems & Management/ Health Economics (on Moodle)
Although the specialty of paediatrics covers a very wide range of clinical medicine, the following
Tables provide a summary of the curriculum and a guide to what we consider to be the most
important topics for Children’s Health rotation. Topics are arranged by both clinical domains (e.g.
respiratory, infections, emergency medicine…etc) and presenting complaint (eg fever, abdominal
pain, failure to thrive). Each clinical topic has been rated in terms of relative importance from R1 to
R3. We have further identified a small group of “Flagship Conditions” (indicated by) which
provide the opportunity to integrate knowledge from Years 1-3 (Years A and B for GMS) into a
clinically relevant context. These are ideal topics to explore in depth.
We are confident that you will find the Children’s Health placement a lot more fun than most
others. We hope you will approach your Children’s Health rotation with an open mind and a
willingness to be involved in the service into which you are placed, and that in doing so, you will
find the rotation stimulating and extremely enjoyable.
We do however expect that you will devote a substantial effort to the rotation. You will find that
spending a few evenings and some weekend time in the Paediatric Emergency Departments and
wards will be a wise investment. We hope you will see the placement as a full time job. If you work
40 hours a week during this rotation, your effort will be well rewarded.
Attitudes and behaviour
It is very important that people working in Paediatrics and Child Health are not only knowledgeable
and skilful, but that they also display the proper attitudes and behaviour to children and their
families. You will be exposed to children with severe disability, social disadvantage and
occasionally acute catastrophic disease. Working in this environment requires a specific blend of
attitudes and behaviour, where the child’s best interests are paramount but the autonomy of the
family is respected. Students occasionally find some of these experiences very confronting and
occasionally disturbing.
We expect you to develop an understanding of the role of doctors as advocates for children. The
best way for you to understand this during your rotation is to look for aspects of that attitude in your
7
tutors. Good communication skills, empathy, a willingness to provide information, and ability to
deal with distressed or angry families are attributes that are central to paediatric practice.
Conclusion
Children’s Health should be a highlight of your Monash course. We hope that you feel welcome,
that you actively participate in the care process and that you can stand back from the bedside
enough to see the global perspective of Children’s Health. You will see logical connections with
your learning of the last three years and we hope that these connections make you feel more
comfortable exploring this new clinical area. For those of you who would like to do more, we would
strongly encourage selectives and electives in final year and would be happy to provide some
advice to you. For those of you who will choose Paediatrics as a future career, getting the basic
foundations in place now will be a great place to start and again we would be happy to help with
advice.
8
Lumps/Bumps/
Accident/Injury
unwell/pale/list
Eye problems
Gait/Posture
Funny turns
child/Fever
Petechiae/
Abdo Pain
Swellings/
Rash/skin
Diarrhoea
Generally
Failure to
Bruising/
Vomiting
Bleeding
Masses
Fitting/
Febrile
and/or
marks
thrive
less
DOMAIN CONDITION/TOPIC RATING
Fallot’s Tetralogy/Transposition Great R1
X
Arteries
Cardiovascular
Kawasaki’s Disease R1 X X X X
Rheumatic fever R1 X
Cardiac Failure R2 X
Infective Endocarditis R2 X X
Patent Ductus Arteriosus R2 X
Ventricular/Atrial Septal Defect R2 X
Coarctation R3 X
Airway Obstruction – Upper R1 X
Allergic Rhinitis R1
Asthma R1
Respiratory
Bronchiolitis R1 X
Croup R1 X
Cystic Fibrosis R1
Pneumonia R1 X X
Obstructive sleep apnoea R2
Tuberculosis R2 X X
Osteomyelitis R1 X X
Septic Arthritis R1 X X X
Musculo-
Skeletal
Juvenile Chronic Arthritis R2 X X X X

Orthopaedic Disorders in Childhood R2 X
Muscular Dystrophy/SMA R3
Epilepsy R1 X
Febrile convulsions R1 X X
Seizures R1 X
Neurology
Migraine R2
Status epilepticus R2
Copyright © Monash University 2011. All rights reserved. Except as provided in the Copyright Act 1968, this work may not be reproduced in any form without the written permission of the host Faculty and
School/Department.
9
Lumps/Bumps/
Febrile child/
Gait/Posture
Funny turns
unwell/pale/
skin marks
Abdo Pain
Petechiae/
Swellings/
Diarrhoea
Generally
problems
Accident/
Failure to
Bruising/
Vomiting
Bleeding
Masses
listless
Fitting/
and/or
Injury
thrive
Rash/
Fever
Eye
Gastroenteritis R1 X X X X
G-O Reflux R1 X X X
Intussusception R1 X X X X X
Gastroenterology
Pyloric stenosis R1 X X X X X
Appendicitis R2 X X X X X
Coeliac disease R2 X X X
Encopresis R2 X
Intestinal parasites R3 X X X X
Inflammatory bowel disease R3 X X X
Necrotising enterocolitis R3 X X
Obstructive Jaundice R3
Diabetes Type 1 (Mellitus) R1 X X X X
Endocrinolog
y & Nutrition
Hypothyroidism R1 X X X
Obesity R1
Protein-energy Malnutrition R2 X X
Vitamin Deficiencies R2 X X X X
Disordered growth R2 X
Nephrotic Syndrome R1
Nephrology
Urology/
UTI/VU Reflux R1 X X X X X
Enuresis R2
Glomerulo-nephritis R2
Conjunctivitis R1
X
URTI/Tonsillitis R1
Ophthalmology
Retinoblastoma R3 X
Strabismus R2 X
Cataract R3 X
School/Department.
10
Gait/Posture
Funny turns
unwell/pale/
child/Fever
skin marks
Abdo Pain
Petechiae/
Swellings/
Diarrhoea
Generally
problems
Failure to
Accident/
Bruising/
Vomiting
Bleeding
Bumps/
Masses
Lumps/
listless
Fitting/
Febrile
and/or
Injury
thrive
Rash/
Eye
Allergic Reaction/Anaphylaxis R1 X X X X X
Emergenc
Medicine
Poisoning/Accidents/Fractures R1 X X X
y
Resuscitation R1
Child Abuse / Neglect R1 X X X X X X
Immunisation R1
Meningitis R1 X X X X X
Chronic Fatigue Syndrome R2 X
Dengue R3 X X X
Infections
HIV Infection R2 X X X X
Malaria R2 X X
Childhood viral infections R1 X X
PUO R2 X
Viral Hepatitis R2 X X X
Infectious Mononucleosis R3 X X X
Idiopathic Thrombocytopenia (ITP) R1 X X
Iron Deficiency Anaemia R1 X
Leukaemia R1 X X X X X
Haematology/
Oncology
Haemophilia R2 X X
Henoch-Schonlein Purpura R2 X X X
Lymphoma R2 X X
Rh/ABO Incompatability R2
Solid Tumours R2
Thalassaemia R2 X
Brain Tumours R3
Autism R1
Developmental Issues
Developmental delay disability R1

Develop. Disability (Rx) R1 X
Down Syndrome R1
Inguino-Scrotal Swellings R1 X X
Abnormal Head Shape & Size R2
Cephalhaematoma R2 X
Club Foot R2 X
Hip Dysplasia R2 X X
Neural Tube Defects R2
School/Department.
11
Lumps/Bumps/
Accident/Injury
unwell/pale/list
Eye problems
Gait/Posture
Funny turns
child/Fever
Petechiae/
Abdo Pain
Swellings/
Rash/skin
Diarrhoea
Generally
Failure to
Bruising/
Vomiting
Bleeding
Masses
Fitting/
Febrile
and/or
marks
thrive
less
APGAR R1
Cerebral Palsy R1 X
Hirschprungs R1
Intrauterine Growth Restriction (IUGR) R1
Neonatal resuscitation R1
Neonatal Sepsis R1 X X X
Neonate/Newborn
Newborn examination R1
Premature birth R1 X
Role of Neonatal Intensive Care R2
SGA (small for gestational age) R1
Birth Asphyxia (HIE) R2 X X
Congenital Abnormality R2 X X
Congenital Infections R2
Feeding/Feeding Problems/Colic R2
Rare but important congenital R2
abnormalities (surgery)
RDS/HMD R2
ADHD R1
Mental Health
Behaviour &
Sleep issues/disturbances R1
Issues
Eating Disorders R2
Tantrums & oppositional behaviour R2
Phobias/Fears/School Refusal R3
X
Common rashes in childhood R1
Eczema R1 X
Dermatology &
Seborrh. Dermatitis R1 X
Rashes
Birthmarks R2 X X X
Herpes Stomatitis R2 X
Measles R2 X X X
Rubella R2 X X
Scabies R2 X
Varicella Zoster R2 X X
School/Department.
12
Issues with growth
Respiratory Signs
Urinary problems/
Muscle weakness
Family planning
Neonatal Health
Aches & pains -
Bone/Joint pain
Cough/Wheeze/
Developmental
Heart Murmur
Constipation
Maintenance
Runny Nose
abnormality
Sore throat/
bed wetting
Behaviour
Headache
problems
Genetics/
muscular
Jaundice
sore ear
Health
Fallot’s Tetralogy/Transposition Great R1
X X
Arteries
Cardiovascular
Kawasaki’s Disease R1
Rheumatic fever R1 X X X
Cardiac Failure R2
Infective Endocarditis R2 X
Patent Ductus Arteriosus R2 X X X
Ventricular/Atrial Septal Defect R2 X X X X
Coarctation R3 X X X
Airway Obstruction – Upper R1 X
Allergic Rhinitis R1
Asthma R1 X
Respiratory
Bronchiolitis R1 X X
Croup R1 X
Cystic Fibrosis R1 X X X X
Pneumonia R1 X
Obstructive sleep apnoea R2 X X
Tuberculosis R2 X X
Osteomyelitis R1 X
Septic Arthritis R1 X
Musculo-
Skeletal
Juvenile Chronic Arthritis R2 X

Orthopaedic Disorders in Childhood R2
Muscular Dystrophy/SMA R3 X X
Epilepsy R1 X
Febrile convulsions R1
Seizures R1 X
Neurology
Migraine R2 X
Status epilepticus R2
School/Department.
13
Issues with growth
Respiratory Signs
Urinary problems/
Muscle weakness
Family planning
Neonatal Health
Aches & pains -
Bone/Joint pain
Cough/Wheeze/
Developmental
Heart Murmur
Constipation
Maintenance
Runny Nose
abnormality
Sore throat/
bed wetting
Behaviour
Headache
problems
Genetics/
muscular
Jaundice
sore ear
Health
Gastroenteritis R1
G-O Reflux R1 X
Intussusception R1
Gastroenterology
Pyloric stenosis R1
Appendicitis R2
Coeliac disease R2
Encopresis R2 X
Intestinal parasites R3
Inflammatory bowel disease R3 X
Necrotising enterocolitis R3 X
Obstructive Jaundice R3 X
Diabetes Type 1 (Mellitus) R1 X X
Endocrinolog
y & Nutrition
Hypothyroidism R1 X X
Obesity R1 X X
Protein-energy Malnutrition R2
Vitamin Deficiencies R2 X X
Disordered growth R2 X X
Nephrotic Syndrome R1 X
Nephrolog
Urology/
UTI/VU Reflux R1 X
Enuresis R2 X X
Glomerulo-nephritis R2
X
y
Conjunctivitis R1
Ophthalmolog
URTI/Tonsillitis R1
Retinoblastoma R3 X
y
Strabismus R2
Cataract R3 X
School/Department.
14
Cough/Wheeze
Developmental
Aches & pains

problems/ bed
Heart Murmur
Constipation
Maintenance
/Respiratory
Runny Nose
abnormality
Sore throat/
Issues with
Bone/Joint
Behaviour
-muscular
Headache
weakness
problems
Genetics/
Jaundice
Neonatal
planning
sore ear
Urinary
wetting
Muscle
growth
Family
Health
Health
Signs
pain
Allergic Reaction/Anaphylaxis R1 X X
Emergenc
Medicine
Poisoning/Accidents/Fractures R1
y
Resuscitation R1
Child Abuse / Neglect R2
Immunisation R1 X
Meningitis R1 X X
Chronic Fatigue Syndrome R2
Dengue R3 X
Infections
HIV Infection R2 X X
Malaria R2
Childhood Viral Infections R1
PUO R2
Viral Hepatitis R2 X
Infectious Mononucleosis R3 X
Idiopathic Thrombocytopenia (ITP) R1
Iron Deficiency Anaemia R1
Haematology/Oncology
Leukaemia R1 X
Haemophilia R2
Henoch-Schonlein Purpura R2 X
Lymphoma R2
Rh/ABO Incompatibility R2 X X
Solid Tumours R2
Thalassaemia R2 X
Brain Tumours R3
Autism R1 X
Developmental Issues
Developmental delay disability R1

Develop. Disability (Rx) R1 X
Down Syndrome R1 X X X
Inguino-Scrotal Swellings R1
Abnormal Head Shape & Size R2 X X X
Cephalhaematoma R2 X
Club Foot R2 X X
Hip Dysplasia R2 X X X
School/Department.
15
Neural Tube Defects R2 X X X
Cough/Wheeze
Developmental
Aches & pains

problems/ bed
Heart Murmur
Constipation
Maintenance
/Respiratory
Runny Nose
abnormality
Sore throat/
Issues with
Bone/Joint
Behaviour
-muscular
Headache
weakness
problems
Genetics/
Jaundice
Neonatal
planning
sore ear
Urinary
wetting
Muscle
growth
Family
Health
Health
Signs
pain
APGAR R1
Cerebral Palsy R1 X X
Hirschprungs R1 X
Intrauterine Growth Restriction (IUGR) R1 X
Neonatal resuscitation R1
Neonatal Sepsis R1 X
Neonate/Newborn
Newborn examination R1
Premature birth R1 X X X X X
Role of Neonatal Intensive Care R2
SGA (small for gestational age) R1 X
Birth Asphyxia (HIE) R2 X
Congenital Abnormality R2 X
Congenital Infections R2 X X X
Feeding/Feeding Problems/Colic R2
Rare but important congenital R2
abnormalities (surgery)
RDS/HMD R2 X X
ADHD R1 X
Behaviour &
Sleep issues/disturbances R1
Mental
Issues
Health
Eating Disorders R2
Tantrums & oppositional behaviour R2
Phobias/Fears/School Refusal R3 X
Common rashes in childhood R1
Dermatology & Rashes
Eczema R1 X
Seborrh. Dermatitis R1 X
Birthmarks R2 X
Herpes Stomatitis R2 X
Measles R2 X X
Rubella R2
Scabies R2
Varicella Zoster R2
School/Department.
16
ASSESSMENTS
Assessment Task Due Date
In semester hurdle requirements:

• Observed Clinical Examinations
• Clinical Clerkship
• Directed Activities
• Case based tutorials
See attached OCE and clinical clerkship End of Semester
assessment record
In semester formative assessments

• Online EMQs
• Clinical skills including: observed clinical In Semester
examinations (neonate/child)
• problem focussed history taking
In semester summative assessments

• Bedside tutorials
• Clinical Case Reports oral and written
(one of each) End of Semester
• Contemporary Issues in Women’s or
Children’s Health
17
CLINICAL LEARNING ACTIVITIES
1. Workshop Week
This week of lectures and workshops in Paediatrics and Child Health will provide you with core
paediatric knowledge in general paediatrics and the subspecialties including paediatric surgery,
and prepare you for your 8 week term on the wards. The programme will be available at the start of
your term.
A list of the clinical meetings for each department is also available.
2. Clinical Clerkship
You should admit patients and write up the admission in the case notes. All entries must indicate
the date and time and you must clearly indicate your name and that you are “Med IV student”
(legibly) at the end of all your entries. Legally this needs to be discussed and signed by the
Resident or Registrar.
Please note that your patients will be under different medical and surgical departments so you will
be presenting to a variety of junior and senior medical staff. It is worthwhile endeavouring to
ascertain when the working ward rounds are expected (the nursing staff usually have a good idea).
The objectives of the clinical ward attachments are:
• To obtain real clinical experience in taking a history, performing an examination and

developing a differential diagnosis and management plan for patients admitted to the
paediatric wards
• To participate in medical and nursing procedures involving your patients
• To succinctly present your patients’ history, clinical findings and management plans to the
junior/senior medical staff on the “working ward rounds”
• To follow the progress of patients during the course of an admission
How to see patients on the paediatric wards at Monash
You will find that seeing patients on the paediatric wards is a little different to adults. Parents and
nursing staff protect them from all sorts of intrusions including medical examinations. Thus, you
may find that permission to see patients may be denied more often on paediatric wards than on the
adult wards.
The correct procedure to obtain consent to take history and examine patients is outlined below.
1. Check the patient’s whiteboard for any restrictions e.g. “NMS” = no medical students please
or “immediate family only”,
Find out which nurse is looking after the patient. If the nurse is at tea then ascertain who is
“covering”. Introduce yourselves and seek permission to see the patient.
- You may be given permission immediately

- You may be asked to see them at a specified time or
- Permission may be denied, with an explanation.
18
2. If permission is given by the nurse then you will need to ask the parent’s and child’s
permission. Most families are very happy to assist in your education, but please be aware
that they have their child’s welfare as their primary focus. If permission is denied, then
please accept this but you may ask if there is any chance of being able to see them later. You
would need to seek permission graciously again from the parents at that time.
3. Please be aware that there are some restrictions that apply to all staff. There is usually a
strictly enforced rest period between 12 and 2pm. Patients may only be seen between 8am
and 8pm unless specifically requested by medical staff.
4. Do not wake up a sleeping child (or parent). Rather arrange another time to see that patient.
5. Permission to take history and examine may be obtained from older children (>14 years) if
parents are not available to seek permission. Parents will have received an explanation about
the importance of your education at the time of admission.
6. Some concerns have been raised about groups of male students examining young female
(especially adolescent) patients. Please do not place yourselves in situations where you may
be compromised. Please ensure you behave in a professional manner at all times with
patients, parents, nursing and allied health workers. If any issues do occur, then please
discuss them with the course coordinator as soon as possible.
3. Observed Clinical Examination (OCE)
The aim is to ensure you have achieved a basic standard of competency in paediatric examination
skills. You will be observed performing two clinical examinations which must be signed off by a
Paediatrician or Paediatric Registrar. This will include the examination of the neonate and infant or
child.
It is important that these tasks are completed well prior to the end of your Children’s Health
rotation.
4. Clinical Bedside Tutorials
Weekly tutorials are to be arranged at times convenient to students and their tutors. They should
be based in the wards. Your participation in bedside tutorials will also form part of your in-semester
assessment.
Each student should prepare for presentation and discussion of a patient they have seen or
admitted. The presentation should occur at the bedside - not in the corridor. It is expected that
students will have sought prior permission from the patient’s family to bring the group for bedside
teaching.
Key clinical signs should be demonstrated and discussed. This should involve active participation
by all students. Tutors will provide feedback in a supportive manner.
Learning objectives of bedside tutorials
• To practice techniques of history taking and communication with patients and their families;
• To learn how to talk and interact with children of different ages;
• To refine skills of clinical examination and interpretation of physical signs
• To discuss management of important Paediatric conditions seen in a hospital setting
(Additional support material: Goldbloom “Paediatric Clinical Skills” is an excellent guide to history
and examination techniques in paediatrics)
19
CHILDREN’S HEALTH –OCE and CLINICAL CLERKSHIP ASSESSMENT
RECORD - 2013
Student Name__________________________________________
Student ID_____________________________________________
You will be required to demonstrate completion of ALL the tasks below before OSCE and MCQ/EMQ results will be released.
Please hand in original assessment record to Mrs Lia Bretag, Southern Clinical School office by 3pm FRIDAY on Week 9 of
your rotation.
(PLEASE ENSURE YOU RETAIN A COPY OF THIS IMPORTANT DOCUMENT).
Hurdle Requirements Signed by Paediatrician or Paediatric Date

Registrar/HMO/Tutor
Observed clinical Print Name: _______________________________
examination (neonate)
see separate sheet for individual
mark
Signature: _______________________________
Observed clinical Print Name: _______________________________
examination (infant/child)
see separate sheet for individual
Signature: _______________________________
mark
Problem focussed history
Print Name: _______________________________
patient/family (No. 1)
Signature: _______________________________
Print Name: _______________________________
Signature: _______________________________
Print Name: _______________________________
Signature: _______________________________
Perform Admission
Print Name: _______________________________
(No. 1)
Signature: _______________________________
Perform Admission
Print Name: _______________________________
(No. 2)
Signature: _______________________________
Problem focussed
Print Name: _______________________________
examination (No. 1)
Signature: _______________________________
Problem focussed
Print Name: _______________________________
examination (No. 2)
Signature: _______________________________
Discharge summary or letter
Print Name: _______________________________
Signature: _______________________________
Paediatric Emergency
Print Name: _______________________________
Department
Orientation Signature: _______________________________
Community/allied health visit

Print Name: _______________________________
(No.1) Name of Site:
Signature: _______________________________
Community/allied health visit
Print Name: _______________________________
(No.2) Name of Site
Signature: _______________________________
20
Observed clinical examination
Based on the American Board of Internal Medicine’s MiniCEX Framework)
Student to return a copy of this form to Lia Bretag, SCS office, MMC
Student’s Name _______________________________________________________________
Student’s Number
Rater’s Name ______________________________
Position – Paediatrician/Paediatric Fellow or Registrar _________________________________
Site  Angliss  Box Hill  Frankston  Dandenong

 MMC  Bairnsdale
 Bendigo  Mildura  Traralgon  Warragul
Patient’s Presenting Problem _______________________________ Sex M/F Age ________
Problem Complexity  Low  Medium  High
Setting  Ward  Consulting Rooms  Emergency Dept.

 Outpatient Clinic  General Practice  Patient’s Home
Patient Examination
Unsatisfactory Borderline Satisfactory Excellent NA
1. Physical Examination Skills
1 2 3 4 5 6 7 8 
2. Professional/Ethical Behaviour
(Including obtaining consent for 1 2 3 4 5 6 7 8 
examination)
Clinical Reasoning Skills 1 2 3 4 5 6 7 8 
Student’s strengths:
______________________________________________________________________________
______________________________________________________________________________
Areas for improvement:

______________________________________________________________________________
______________________________________________________________________________
I verify that this student was observed with a patient. Date ____/____/2012
Assessor’ Signature _______________________ Student’s Signature _____________________
Copyright © Monash University 2011. All rights reserved. Except as provided in the Copyright Act 1968, this work may not be reproduced in any form
without the written permission of the host Faculty and School/Department.
21
Student Attributes: Physical Examination Skills Rating
• Performs a cursory examination leading to incomplete, inaccurate or erroneous picture of signs
and general state of the patient.
• Examination conducted in an unstructured manner, with little or no coherence, and many (50%
or more) important elements that should have been covered in the available time omitted or
covered cursorily. 1 -2
• Student seems unsure and/or uncoordinated in examination technique. Student is rough or
appears to hurt the patient. (Please intervene if this occurs - see guidelines)
• Student retains an incomplete picture of the results of the examination.
• Performs an examination with frequent incomplete elements producing an inaccurate or
erroneous picture of signs and general state of the patient.
• Examination conducted in an unstructured manner, with little or no coherence, and many (50%
or more) important elements that should have been covered in the available time omitted or
covered cursorily.
3-4
• Student seems unsure and/or uncoordinated in examination technique.

• Student retains an incomplete picture of the results of the examination.
• Occasional missed elements of the examination (<20%), but mostly a coherent and structured
approach to patient examination in which the most important systems for the presenting
complaint are covered.
• Signs salient to exclusion of one or more diagnoses are reviewed.
• Student seems reasonably coordinated in most examination techniques. 5
• Student informs patient about most of the imminent examinations and asks for permission before
undertaking intimate components of these.
• Student retains a comprehensive picture of the results of the examination as performed.
• Very few missed elements of the examination which are mainly confined to unimportant or
contraindicated aspects.
• A coherent and structured approach to patient examination in which the most important systems
for the presenting complaint are covered.
• Signs salient to exclusion of one or more diagnoses are reviewed.
6
• Student seems reasonably coordinated in most examination techniques.
• Student informs patient about most of the imminent examinations and asks for permission before
undertaking intimate components of these.
• Student retains a comprehensive and coherent picture of the results of the examination and can
identify areas that perhaps should be followed up.
• Missed elements of the examination are confined to contraindicated or risky aspects.
• Student can justify the examination performed. A coherent and structured approach to patient
examination in which all important systems for the presenting complaint are covered.
• Signs salient to both inclusion and exclusion of one or more diagnoses are reviewed. Student
seems slickly coordinated in most examination techniques.
• Can describe what he/she is doing to observer as it happens, without alarming or confusing 7-8
patient.
• Student informs patient about all of the imminent examinations and asks for permission before
undertaking any intimate components of these.
• Student retains a comprehensive and coherent picture of the results of the examination and can
identify areas that he/she is weaker on.
22
CLINICAL BEDSIDE TUTORIALS
(In semester Marking Sheet)
Student’s Name
Clinical Instructor:
Site/Group/Rotation: Rotation:
Rotation & (Please circle one mark for each section)

Site:
History and Examination
Area for improvement: Data gathering and reporting are incomplete or disorganised.
1 Incomplete examination (physical/mental status)
Between Area for improvement & Competent

2
Competent: Gathers pertinent data, reports in an organised fashion. Competent examination
3 (physical/mental status)but occasionally misses clinical findings
Between Competent and Strength

4
Strength: Data complete and concise, presentations and clinical notes organised & clear.
5 Physical & mental examination thorough, directed when appropriate and usually reliable
Clinical Reasoning
Area for improvement: Rarely (<25%) able to generate a differential including the most likely
1 and “do not miss” diagnoses. Difficulty with clinical reasoning

2
Competent: Often (50%) able to generate a differential including the most likely and “do not
3 miss” diagnoses. Demonstrates clinical reasoning

4
Strength: Usually (75%) able to generate a differential including the most likely and “do not
5 miss” diagnoses. Demonstrates clinical reasoning
Clinical Management
Area for improvement: Rarely (<25%) able to suggest appropriate tests or therapy. Relies on
1 seniors almost exclusively

2
Competent: Often (50%) able to suggest appropriate tests or therapy. Looks up questions.
3
4
Strength: Usually (75%) able to suggest appropriate tests or therapy. Incorporates outside
5 reading
Page 1 of 2
Please return to Lia Bretag, Southern Clinical School Office, Level 5, Block E, 246 Clayton Road, CLAYTON 3168.
OR by FAX to 9594 6495. Thank you.
23
Learning
Area for improvement: Rarely (<25%) does outside reading and then doesn’t
incorporate into patient care. Relies on seniors for learning. Knowledge base is of
1
concern

2
Competent: Reads about patient problems and general relevant topics. Should
3 read more.

4
Strength: Reads texts independently Summarizes information to colleagues.
5 Beginning to teach others
Interpersonal Skills
Area for improvement: Often poor rapport with patients and colleagues,
1 disorganised disrespectful. Rarely empathic.

2
Competent: Average rapport with patients and colleagues, respectful. Able to
3 demonstrate empathy.

4
Strength: Excellent rapport with patients and colleagues. Regularly empathic.
5
Professionalism
Area for improvement: Poor attendance at clinical tutorials, unprepared, poorly
1 attentive.

2
Competent: Prompt, usually well prepared, Shows some initiative in seeking
3
patients and monitoring progress.
4
Strength: Always well prepared. Self directed, involved in patients’ care and their
5 progress
Areas of strength:
Comments or concerns – specific examples are very helpful:
Have you discussed this with the student? Yes No
Total: /30
Tutor Name:
Tutor Signature:
Date:
Adapted from Uni Washington clinical clerkship program Page 2 of 2
Copyright © Monash University 2011. All rights reserved. Except as provided in the Copyright Act 1968, this work may
not be reproduced in any form without the written permission of the host Faculty and School/Department.
24
5. Directed Activities
Directed Activities cover a broad selection of important topics from the child health curriculum. The format
allows for independent learning and it is expected that students will cover the content during their Child
Health rotation. A subset of topics will be selected for group discussion during tutorials.
These clinical and theoretical activities cover core paediatric knowledge. (Refer Directed Activities Guide).
They form the basis of the practical application of the curriculum and may be discussed in your tutorials. They
are designed to assist the students to identify key aspects of common paediatric conditions and to emphasize
the clinical application of theoretical knowledge.
“Directed Activities” are also examples of typical OSCE’s, that you may encounter during summative
assessment at the end of the year.
6. Case Based Tutorials
These problem based learning activities discuss evidence based clinical practice and the broad management
of clinical cases. This includes medical management with an emphasis on the social, ethical and legal
aspects of patient care, and the interaction of a multidisciplinary team of health care professionals. Groups
will incorporate both Women’s Health and Children’s Health students in discussion groups and will be
facilitated by a tutor.
The aims of Case Based Tutorials are to teach clinical behaviours, attitudes and knowledge beyond what you
can reasonably learn from a textbook. In addition they attempt to teach students the art as well as the science
of medicine.
Case Based Tutorials are structured, interactive, patient based but held away from the bedside. They are led
by a clinician/expert (not a generic tutor) and involve the tutor sharing their wisdom and students are
encouraged to talk about their recent clinical experience.
Tutorials are structured under 6 domains, namely Professionalism, Evidence-base, Ethics, Roles,
Legal/Social and Systemic issues and a series of student-selected cases will be used to explore these
domains. Further instructions are contained within the Case Based Tutorial handout.
7. Clinical Case Reports
During your Children’s Health rotation, you are required to prepare two case study reports (one written, one
oral) about an infant, child or adolescent with whom you have been involved. The intention in having you
prepare these case reports is to help you make the link between the patients and their real world problems,
and the body of theoretical knowledge which is available to you through textbooks, journals, literature searches
and so on.
The first is to be completed by Week 5 and the second to be completed by Week 9.
Each assessment will contribute towards the final mark for Children’s Health.
25
Objectives of case reports
• To demonstrate an ability to summarise a patient’s clinical details into a succinct description that
includes relevant positive and negative data and excludes irrelevant and distracting details - this skill
will be important when you are a intern/resident discussing patients on ward rounds or in the middle
of the night with your consultant
• To demonstrate an ability to link practical clinical management with theoretical knowledge
• To identify an aspect of patient management that can be investigated to expand your depth of
knowledge - this is how you will be learning during your internship and junior residency
• To practice the skills of formal oral presentations to peers and colleagues, including the use of visual
aids such as overhead projection or computer generated slides (e.g. PowerPoint) or to practice the
skills of formal written presentations to peers and colleagues including the correct use of common
English and Medical terminology
Selection and presentation of cases
• Two cases are to be submitted by each student: one written and one oral. These are to be in a typed
written format and completed by the end of Week 5 and Week 9.
• Students are to include the initials of the first and surname of the patient and the patients UR in the
case report
Helpful hints
• Do choose a relevant paediatric case

• Do present a succinct but complete history and examination with investigations and an outline of the
child’s management
• Do choose an issue relevant to the case which interests you
• Do choose issues which complement your study program
• Do provide appropriate references. Don’t quote rare journal references. If you quote something you
have read in a textbook, the textbook itself is sufficient reference rather than the original source material
• Don’t overdo it and let these case reports become an end in themselves. They do not replace clinical
work on the wards and they should not take you a week of full time work to prepare each one
• Don’t choose overly esoteric or inappropriate topics. We are concerned with your basic education in
paediatrics, and although delighted when students take an interest in the whole discipline, we need to be
sure that core topics are covered adequately
• Don’t spend inappropriate amounts of time on computer graphics and fancy layout
• Don’t discuss issues which are not actually relevant to the case presented. For example, don’t discuss
adolescent psychological aspects of a chronic disease when you have presented a two year old unless
you can demonstrate the relevance
26
The case studies should take the following format:
• A succinct but complete and accurate presentation of the important history and examination
findings
• The differential diagnosis at admission or at the time you first saw the child
• The relevant investigations and their results
• The treatment undertaken and its effect
• The main body of the case report should be a discussion of one or more aspects of the case you
have presented. This should highlight the links between clinical management and theoretic
knowledge as well as exploring to some depth one aspect of the clinical case or management.
• Clinical summary
Please note:
• The written report should be typewritten, approx 1,000 words. It should include a bibliography (not
included in word count) of 5 to 10 relevant references
• The oral presentation should be of 10 minutes duration. Either typed overhead transparencies or
PowerPoint presentations may be used. The latter should use simple designs, graphics should be
limited to relevant clinical material
Assignment Submission
Case study number 1 should be submitted by the Friday of week 5 and number 2 should be submitted or
presented by the Friday of week 9. On your Monash Rotation, you are to hand in your written case report (hard
copy) to Ms Lia Bretag, Undergraduate Education Administrator, in the SCS office, Level 5, E Block, MMC by
the last Friday of the rotation before 3.00pm.
You are also required to email an electronic version to Ms Lia Bretag at angelina.bretag@monash.edu
please ensure you keep an electronic copy on your own PC.
Late Assignment Policy
• Assignments must be handed in by 3.00pm on the specified day.

• Late submission will incur a penalty of 5% of the total mark deducted for each day, or part thereof
• If an assignment is more than 10 days overdue it will be examined for pass standard – it still must be
completed to a satisfactory (i.e. pass) standard to fulfil hurdle requirements.
• No penalty will apply if an extension has been sought by the student and granted by the person
responsible for the activity or their delegate prior to the time and date for submission
ASSESSMENT
Both the written report and oral presentation will be marked out of 10
The marking of both the written report and oral presentation will be based on the four objectives (refer
marking sheet following pages)
Assessors
The bedside clinical tutor for the rotation at the time the case is submitted is responsible for the
assessment. The term supervisor may delegate the assessment to one or more senior medical
practitioners (not necessarily an academic or conjoint appointee) associated with the term.
27
Clinical Case Reports Marking Sheet 2013
Site: Rotation:
Dr Marker’s signature:
Date:
Student Name
• Student ID
• Presentation:
• Topic __________________________________________________________
Objectives
To demonstrate an ability to summarise a patient’s clinical details into a succinct description that includes relevant
positive and negative data and excludes irrelevant and distracting details.
(3 Marks).
Major omissions, excessive brevity and not arranged in appropriate sections 0 Marks
Some omissions or excessive brevity or not arranged in appropriate sections 1 Mark
No major omissions, adequate detail, arranged appropriately, inadequate synthesis 2 Marks
No major omissions, adequate detail, arranged appropriately and satisfactory synthesis of information 3 Marks
To demonstrate an ability to link practical clinical management with theoretical knowledge:

(3 Marks)
Failed to adequately address the objective 0 Marks
Satisfactorily addressed the objective 1 Mark
Addressed the objective well 2 Marks
Demonstrated link between practical management and theoretical knowledge very well 3 Marks
To identify an aspect of patient management that can be investigated to expand your depth of knowledge:
(3 Marks)
Failed to discuss adequately 0 Marks
Satisfactory discussion 1 Mark
Good discussion to appropriate depth 2 Marks
Excellent discussion to appropriate depth with appropriate references 3 Marks
To practice the skills of formal oral presentations to peers and colleagues, including the use of visual aids such as
overhead projection or computer generated slides (e.g. PowerPoint) OR to practice the skills of formal written
presentations to peers and colleagues including the correct use of common English and Medical terminology.
(1 Mark)
Failed to adequately address the objective 0 Marks
Satisfactorily addressed the objective 1 Mark

TOTAL: /10
Please return ASAP to Lia Bretag, Southern Clinical School, Level 5, 246 Clayton Road, CLAYTON 3168. OR BY
FAX – 9594 6495. Thank you.
28
Student Misconduct - Plagiarism and Collusion
Each individual written assignment MUST have a “Monash University Individual Assignment Cover Sheet”
signed and attached to the front of your written work. A copy of this form is located at the end of this guide.
(One is also included in your package on “Intro Morning”).
Plagiarism is considered a serious professional misconduct and will be dealt with according to the Faculty
policies.
More detailed information can be found on the following website.

http://www.policy.monash.edu/policy-bank/academic/education/conduct/plagiarism-policy.html
These forms are located and downloadable on the Monash web site at:
www.med.monash.edu.au/mucaps/files/individual_coversheet.do
8. Contemporary Issues in Women’s and Children’s Health
Contemporary Issues in Women’s and Children’s Health provide an opportunity to understand some of the
broader public health issues affecting the health of women and children in industrialised countries as well as
in middle and low income countries, where women and children continue to carry very heavy burdens of
preventable disease. Since our University straddles campuses in different countries and we anticipate that
many of you may choose to work, at some stage of your career, in less developed countries we believe it is
important for you to have some exposure to priorities and programs in these other countries
.
These contemporary issues also emphasise the broad perspective taken in the course, in which we are
concerned with more than just the management of disease in individual women and children. Our use of the
terms “Women’s Health” and “Children’s Health”, rather than Obstetrics and Gynaecology and Paediatrics,
reflects this emphasis. Your journey through the Monash MBBS course will already have made you aware of
the principles of health promotion, the impact of public health policy and practice and the importance of the
relationship between individuals, their families, their communities and the larger societies in which they live.
Since health outcomes for women and children are so closely intertwined and since many of these broader
public health perspectives have interrelated relevance for both women and children, they will be dealt with
together in this section of your program.
Learning Objectives
• To gain public health perspectives on the most important health problems affecting women and children
in different countries across the globe.
• To describe health priorities for women and children in industrialised, middle and low income countries
and the separate approaches that are needed to tackle these health problems in different contexts.
• To meld clinical approaches that are needed for the diagnosis and management of individual health
problems with public health approaches to the solution of health problems for entire communities.
• To work collaboratively with other students in small groups to research, discuss and prepare selected
contemporary issues for presentation and dissemination to the year 4 class.
29
Description of the Task
For this educational task you will be divided into small groups of 6-8 students. Each group will either be asked
to select or may be assigned one of the topics in the list below. Thereafter, you will be required to research
the topic as a group and prepare a combined presentation in which each group member should ideally have
some role. You will be marked by your tutors on your presentation – the marking sheet is attached – and on a
short 2-page written summary that you produce on the same subject. The summary will be posted on the
faculty website for access by other members of your class at different sites in Australia and Malaysia.
These group presentation sessions are designed to help students consider some of the broader issues in
Women’s and Children’s Health in a way which is entertaining and stimulating and which also allows them to
cover a number of key topics through collaborative effort with their colleagues.
Guidelines for preparing the syndicate presentations
Each member of the syndicate groups needs to make a reasonably equivalent contribution to the overall
effort, and each group is expected to provide brief indications of the level of contribution to the various
components. Topics are assigned to group representatives at the beginning of the rotation and the groups
prepare both a 10 minute presentation suitable for delivery on the scheduled day to an audience of
classmates and a two page handout. Copies of the handout are to be distributed to the whole group and
include a summary of key information, references, URLs and other important documentary evidence as well
as the key messages teams wish to convey. By the end of the semester everyone will have the same
material, but with special connection to the topic which they helped their own group to prepare.
The topics allocated include references to areas students may wish to cover in the overall package of the
presentation. These dot points are not meant to be exclusive or comprehensive and evidence of original
thinking or novel approaches to the issue will be most welcome. Up to date information to allow preparation of
the presentation and document is readily available from texts, periodicals and especially from the Internet.
Students should do a fairly careful search for relevant material which might summarise the circumstances
surrounding a particular topic, then prepare their presentations to reflect the key messages they wish to
deliver. There are often specific government or non-government agencies devoted to specific issues (e.g. the
Children’s Safety Centre at the Royal Children’s Hospital) and the web sites for groups such as this are often
extremely helpful. Where there might be controversies surrounding an issue (e.g. in water fluoridation)
students should take care to understand both sides of the argument and to review arguments critically and
with care.
Format of the group presentations
The format of the presentation is up to the students collectively. We suggest that they develop an
entertaining, interactive and informative presentation which will keep the attention of their colleagues and get
key messages across. Remember that they have the opportunity to provide specific detail in the handout, so
the presentation and the handout should complement each other rather than simply match each other.
Assessment
Each student group will deal with a single topic in Women’s or Children’s Health. Many of these topics
straddle the fields of women’s and children’s health but some may apply exclusively to one of these discipline
areas. The group will be given a group mark which contributes 5% to the final mark for each of the two
disciplines. See marking sheet below. These topics are considered part of the core content and may also be
incorporated into short questions and OSCE assessments at the end of the semester. Students are therefore
encouraged to review the short summaries produced by other student groups in their preparation for the final
examination
30
TOPIC LIST: “CONTEMPORARY ISSUES IN WOMEN’S AND CHILDREN’S HEALTH”
AUSTRALIA
1. Issues in Immunisation 2. Childhood Accidents and Injuries

• The Australian Schedule • Statistics
• The Childhood Immunisation Register • Prevention strategies
• Controversies • Priority programs
• The anti-immunisation lobby • The role of government policy
• The future of Immunisation • Education programs and their effectiveness
3. Poisoning and Ingestions 4. Fluoride Deficiency
• Statistics • History and impacts
• Prevention strategies • Strategies to combat fluoride deficiency
• Priority programs • The anti-fluoridation lobby
• The role of government policy • Distribution of fluoridation programs in Victoria
• Education programs and their effectiveness • Controversies
5. Youth Suicide in Australia 6. Drugs and Alcohol
• How big and pervasive is the problem? • Patterns of use in mothers and children
• Contributing causes • Impact of abuse during pregnancy on child
• Policy Initiatives health
• Community Programs • Treatment and prevention programs
• Tackling FAS1 as a public health problem
7. Effect of SES2 on Maternal and Child Health 8. The Health of Indigenous Mothers and Children
• How do you measure socio-economic status? • Health disparities between Indigenous and
• What frameworks are available to assess the effects non-Indigenous mothers and children -
of social determinants on MCH 3? statistics
• Pick and tackle an important MCH problem for which • MCH priorities in Indigenous communities
social determinants are the key driver • Role of government interventions
• Successful programs and how they are
measured
9. Parenting in the 21st Century 10. Child/Youth Homelessness
• How has parenting changed in the last 50 years? • How big a problem is this in Australia?
• Which social factors have caused those changes? • What are alternatives to the modern nuclear
• Have these changes had a good or bad effect on the family?
physical and mental health of children? • Government responsibilities
• Parenting programs - what can be done to assist • Policy initiatives
mothers and fathers in their parenting roles? • Community Programs
11. Childhood Obesity 12. Education of Children with Disabilities?
• Statistics • What do parents want for their children?
• Impact on the health of children • Special vs mainstream education – who
• Policy Initiatives benefits?
• Individualised versus community programs • Special schools or special units within schools
• What works? • Facilities for children with learning disabilities
• Roles of teachers, health professionals,
parents
1
FAS = Foetal Alcohol Syndrome
2
SES = Socio-Economic Status
3
MCH = Maternal and Child Health
31
13. Child Abuse and Neglect 14. Domestic Violence
• What is the size and shape of this problem? • Defining domestic violence
• Identifying and helping families at risk • What is the true extent of the problem?
• Legal responsibilities for child protection • At risk groups
• Community programs for perpetrators • Programs and strategies
15. Teenage Conception 16. Birth weight and chronic disease
• What is the size of the problem in Australia? • “Foetal origins” hypothesis
• Short-term and long-term health impacts • Epidemiological evidence to support the
• Stigma and community responses hypothesis
• Implications for the health of the baby • Implications for prevention
• Initiatives to support teenage mothers • Australian populations at risk
• Community programs to improve birth weight
17. Termination of Pregnancy (TOP) 18. Pregnancy and Birth Care Options in Australia
• Public opinion in Australia on TOP • What do mothers want?
• Right to life versus right to choice • Different models of pregnancy and birth care
• Legal guidelines for TOP in Australia • Role of midwives, GPs, Obstetricians in these
• Disparities in the availability of TOP in Australia models
• RU486 – controversies • Emergency transport services
• Risks and benefits in different settings
19. Antenatal Screening 20. HPV Vaccination
• Framework for population screening in Australia • Prevalence of genital HPV & expected impact
• Current recommended antenatal screening tests • Target groups
• Evidence for effectiveness of antenatal screening • Mechanism of Action
• Future additions to routine screening tests • Controversies
MALAYSIA, SOUTH AFRICA
21. Maternal Mortality in Developing Countries 22. Childhood Malnutrition in Developing Countries
• How big is the problem of MM 4 • Acute versus chronic malnutrition
• When in pregnancy or child birth do women die? • Wellcome vs Waterlow classification of
• Why do women die? malnutrition
• Where do maternal deaths take place? • Interventions to improve nutrition and child
• What are the risk factors for maternal death? survival
• What works?
23. Integrated Management of Childhood Illness 24. Child Health in a time of Armed Conflict
• Objectives and Goals of IMCI • Global statistics - What is the size of the
• Principles and content problem?
• Target groups and conditions • How does armed conflict affect health of
• Facility-based and community-based elements children?
• Impact on child survival • Social and mental health impacts
• International advocacy and assistance
• Community programs
25. Vitamin A deficiency in Developing Countries 26. Safe Motherhood Initiative (SFI)
• Vitamin A deficiency in different regions of world • History and goals of SFI
• Clinical signs of Vitamin A deficiency • Main components of the program
• Vitamin A deficiency and mortality from measles and • What impact has SFI had on MM in the last 20
pneumonia – what is the evidence years?
• Programs to combat Vitamin A deficiency • Obstacles and barriers to implementation.
• New proposals for program renewal
4
MM = Maternal Mortality
32
27. Expanded Program on Immunisation 28. Breast Milk Substitutes in Developing Countries
• History of EPI • Risks of formula feeding in developing
• Debate on selective versus comprehensive PHC 5 countries
• Vaccination coverage in different WHO regions • International code for marketing of BM6
• What are the essential elements of EPI? substitutes
• Program impacts since inception • Milk companies versus Child Health
advocates – what are the arguments?
• BM substitutes – is there a need in a time of
AIDS?
29. Program to Prevent MTCT of HIV Infection 30. Fertility Regulation in Developing Countries
• Transmission routes and relative risks • Global fertility trends by WHO health region
• Procedures for safe delivery • Appropriate fertility regulation methods for the
• HIV testing and counselling developing world
• Anti-retroviral treatment for mothers and infants • Programs to reduce fertility in last 30 years
• Infant feeding options • Fertility regulation and the status of women
• Treatment, care and social support for families • Successes and failures
31. Female Genital Mutilation (FGM) 32. State of the World’s Children
• Prevalence in different regions of the world • Measuring child health status – what are the
• Social and cultural influences on practice of FGM most useful indicators?
• Procedures and their health impacts on women • Child Health trends by WHO health region
• International advocacy and legal protection • What are the Millennium Development Goals?
• Interventions to reduce FGM • Progress with MDG 7’s in Australia, Malaysia
and South Africa?
33. AIDS Orphans 34. Syndromic Management of STI 8’s
• Statistics – Global burden by health region • Prevalence of STI’s – challenges of
• Options and models for care of AIDS orphans identification
• Strengthening communities • Rationale for “syndromic” approach to
• Characteristics of exemplary care programs management
• Management protocols and flowcharts
• Program impact to date
35. Diarrhoeal Disease Control Programs 36. MCH Programs in Malaysia
• Burden of childhood diarrhoea and its impact on child • District health systems for PHC5 in Malaysia
mortality in developing countries • Components of the MCH strategy
• Implementing oral rehydration therapy in this context • MCH indicators in Malaysia and South Africa
• Clean water and sanitation • Description of MCH program in a Malaysian
• Role of breast feeding in this program district
• Program impact • Why has Malaysia been so successful in
implementing its MCH strategy?
5
PHC = Primary Health Care
6
BM = Breast Milk
7
MDG = Millennium Development Goals
8
STI = Sexually Transmitted Infections
33
Year 4 MBBS Contemporary Issues in Child Health Assignment
Statement of group member contributions
Indicate contributions made by each group member to the assignment by listing the member name and ticking the appropriate box. The workload for the
assignments should be distributed as evenly as possible across the group. The level of contribution by each member will vary across the task categories and this
can be reflected by giving or a significant contribution or effort 2 ticks. It is appropriate to leave a box blank if the group member was not required contribute to that
particular task.
This form must be completed by the group and submitted with your handout at the presentation session.
Name of Group Member Planning Search Analysis & Devising & Handout Giving
presentation Literature Interpretation creating Preparation Presentation
of Information presentation
School/Department.
34
Contemporary Issues in Child Health (20 Marks)
Topic: Date: ......... / ......... / 2010
Group: Marker:
Objectives:
The group presentation sessions are designed to encourage you to consider broader issues in Child
Health, and to cover a number of key topics through collaborative effort with your colleagues. The
discipline of Paediatrics advocates for health and resilience in children and sees health promotion and
public health as part of the normal process of care for children. You have the opportunity to provide
specific detail in the handout, so your presentation and your handout should complement each other.
Marking will be based on both presentation and handout.
Objective 0 1 2 3 4 5 6
Content:
Identifies issues / clearly defines planned
coverage
Addressed all sections adequately
Logical interpretation of data
Includes consideration of implications / impact
on Child Health practice
Research & Handout:
Literature search satisfactory and appropriate,
referenced appropriately
Information from government & community
groups, as appropriate
Handout succinct, complements presentation
Presentation:
Engaging presentation
Use of visual media; Originality of approach
Logical sequence
Health promotion approach / Informational
Participation:
Statement of roles and contribution
Rationale for presentation mode
Comments:
Signed: TOTAL: / 20
Copyright © Monash University 2011. All rights reserved. Except as provided in the Copyright Act 1968, this work may not be reproduced in
any form without the written permission of the host Faculty and School/Department.
35
GENERAL MEDICAL AND SPECIALTY PAEDIATRICS
MMC
All children are admitted to wards 41N and 42N on Level 4. Each team has a resident and registrar and
you should introduce yourself to them and enquire about ward rounds and teaching activities for that
department.
Learning Objectives
• To understand the common medical problems associated with babies and children
• To diagnose and manage common medical conditions in children
• To recognise paediatric medical emergencies
• To be competent in taking a history, performing a physical examination, creating a differential
diagnosis and treatment plan for common conditions.
Method
• Get involved in the care of patients by being on the wards, ED and outpatient clinics.
Non Monash students
Please consult local administrators for arrangements at your local site.
36
PAEDIATRIC SURGERY
During your Children’s Health rotation, you should aim to involve yourself in the surgical care of several
children.
Learning Objectives
• To understand the common surgical problems associated with babies and children
• To diagnose and manage common causes of abdominal pain in children
• To recognise the paediatric surgical emergencies
• To be competent at performing an inguinoscrotal examination on children
Method
Getting involved in the care of surgical patients by:
• Attending the four structured lectures (1 hour/week). Prof Cheng/Prof Héloury

• Attending one bedside tutorial per week. Mr Ferguson
• Attending a minimum of two ward rounds per week (starts at 7.30am in 42N)
• Attending a minimum of two outpatient clinics per week (Tues am, Wed am Thurs pm)
• Attending a minimum of one operation session (Mon am, Tue am, Wed pm weekly, Thu Fri)
Location
Ward 42N, Level 4, Monash Medical Centre, Ward rounds starts at 7.30am
Surgeons
Mr Chris Kimber
Head Paediatric Surgery
Professor Yves Héloury Mr Robert Stunden Mr Jo Crameri Mr Tom Clarnette

Mr Neil McMullin Ms Liz McLeod Ms Gwynn Wilson Mr Peter Ferguson
Ms Nathalie Webb
Having difficulty finding the Surgeons?
1st option – page the oncall paediatric surgical registrar through Switch ext 92
2nd option – phone Paediatric Surgery Secretary, Jasna on 46998
3rd option – phone Children’s Health Secretary, Lia Bretag on 47645
Non Monash students
37
EMERGENCY DEPARTMENT
Students are to attend the 9.00am orientation on the first Monday of your Emergency Week with
Dr Adam West or the Fellow. If you are unable to attend, you will need to contact Dr Adam West
prior to the orientation with a valid reason or you may be unable to undertake the remainder of
the week. ED is not able to orientate students in multiple sittings and you are not permitted to
attend ED without an orientation.
Students are rostered to attend the paediatric Emergency Department (ED) for one week for formal
tutorials, scenario teaching and practical exposure to the variety of cases that presents to the
paediatric emergency department. Students doing ED week should ensure that they attend their
case based tutorials and bedside tutorials during that week. The focus is on the recognition of the
sick child, resuscitation, clinical assessment and decision making and management.
The students are expected to assess the patient with a full history and examination and formulate
an appropriate course of management and then present this to the registrars or fellow. You should
aim to follow at least 3 patients from beginning to end of their ED management. The students
should take the opportunity to be involved in any procedures that may be required e.g. manipulation
of fractures, lumbar punctures and to follow the patients should they require investigation in other
departments e.g. CT scan, ultrasound. Students are welcome to follow up their patients on the
wards. The Paediatric Emergency Fellow should be contacted on the first day of the rotation in the
Emergency Department. You will be allocated specific evening shifts during your week in the ED.
It is expected that students self roster for the week with not more than 2 students in the department
at any one time. eg AM and PM shifts (students are requested not to attend night-shift due to ED
workload)
Learning objectives
To have an understanding and knowledge of the assessment and management of the common
conditions with which children present to emergency departments
• To be able to relate to the children and their parents or guardians in the emergency
department
• To be competent in taking a history and performing an examination of children with acute
illnesses and injuries
Responsibilities
• Attend the Emergency Department on Monday morning of the week in emergency at 9am
and meet with the Paediatric Fellow
• Allocate students to the timetable to attend emergency in pairs. It is important due to the
physical restraints of the Emergency Department that students only attend for the clinical
attachment in pairs
• All students are expected to attend teaching sessions
• Students will be allocated a case based learning package and it is anticipated that these
activities will be completed at times when students are not in the clinical area
• It is recommended that students maintain a log book of the patients that they have seen
and procedures that they have performed or seen
• The Friday morning and afternoon sessions will discuss the case based learning modules,
and review the logbook
Non Monash students
38
Feedback
Monash is committed to excellence in education and regularly seeks feedback from students,
employers and staff. One of the key formal ways students have to provide feedback is through SETU,
Student Evaluation of Teacher and Unit. The University’s student evaluation policy requires that every
unit is evaluated each year. Students are strongly encouraged to complete the surveys. The feedback
is anonymous and provides the Faculty with evidence of aspects that students are satisfied and areas
for improvement.
Our Feedback to You
Students will obtain verbal feedback on observed clinical examinations which form part of the hurdle
requirements for the unit. Students will be able to complete online formative EMQs in semester.
Immediate electronic feedback is provided with a brief explanation of the correct answers.
Students will receive the marks of their in semester summative assessments and will be able to
compare them with the results of their peers (in de-identified format). Students who fail individual in
semester summative assessments will be notified of the result and offered individual feedback and
counselling.
Your Feedback to Us
Monash is committed to excellence in education and regularly seeks feedback from students,
employers and staff. One of the key formal ways students have to provide feedback is through SETU,
Student Evaluation of Teacher and Unit. The University’s student evaluation policy requires that every
unit is evaluated each year. Students are strongly encouraged to complete the surveys. The feedback
is anonymous and provides the Faculty with evidence of aspects that students are satisfied and areas
for improvement.
The Department of Paediatrics encourages student feedback through questionnaires circulated during
Workshop week as well as an online survey of the children’s health course circulated with the online
formative EMQs. This information is fed back to individual sites and contributes to future development
and modification of the children’s health course.
• A feedback questionnaire is attached to the Formative EMQs. This is your opportunity to give
us feedback on the teaching and clinical exposure you have received
• A feedback form is given to every student at the end of workshop week
Previous Student Evaluations of this unit

If you wish to view how previous students rated this unit, please go to
https://emuapps.monash.edu.au/unitevaluations/index.jsp
39
Recommended Resources
Paediatric Medicine
th
Roberton DM, South M. Practical Paediatrics 6 Edition. Churchill Livingstone 2007.
or
rd
Lissauer T, Clayden G. Illustrated Textbook of Paediatrics Mosby 2001 3 Edition.
Paediatric Surgery
Hutson JM. Jones’ Clinical Paediatric Surgery: Diagnosis and Management 5th Edition Oxford University Blackwell
Scientific 2000.
Paediatric Clinical Examination

Goldbloom R. Paediatric Clinical Skills 3rd Edition Churchill Livingstone 2002. (An outstanding book in its own
right and quite different from a standard text)
th
Gill D, O’Brien N. Pediatric Clinical Examination Made Easy 4 Edition. Churchill Livingston 2003.
Other Texts
Haddad, D, Greene, S, Olver, R Core Paediatrics and Child Health Churchill Livingstone 2000.
Management Guidelines: Developmental Disability 2. 2nd Ed. (2005). Melbourne. Therapeutic Guidelines Ltd.
As one of the well priced Therapeutic Guidelines series, this text provides concise and practical information about
the management of both children and adults with developmental disability. The book is well indexed, and an
extensive list of resources, including web sites, is included. It is available from Monash Bookshop or Therapeutic
Guidelines (www.tg.com.au) for $30 (student price).
CD
Child Growth & Development in the first 12 months. (The CD is an interactive problem based educational program.
Version 2.4 is available from the Monash University Bookshop at a subsidised cost of $6.00 per CD. It is an
excellent learning tool about normal infant behaviour and development).
Child Growth & Development during the Toddler & Pre-school years. (This CD is an interactive, problem based
educational program. The program demonstrates individual variations of normal development in children during the
toddler and pre-school years reflecting the complex nature of cognitive and language development. Version 1.1 is
available from the Monash University Bookshop at a subsidised cost of $6.60 per CD).
Tracy, J & Burbidge, M. (2005). Healthcare Scenarios in Developmental Disability Medicine [CDROM]. Melbourne,
Australia. Centre for Developmental Disability Health, Monash University.
This interactive multimedia CD introduces 4 people with developmental disabilities and demonstrates how their disability
impacts on their medical care. An overview of developmental disability (including terminology) is provided, general issues
in healthcare are outlined, communication aids and strategies are shown, mental health and illness in people with
intellectual disability is explained and the issues of families and carers are explored. The product is extensively illustrated
with video and still images, and anecdotes and personal stories. A glossary of terms and a list of resources are included.
Available from Monash Bookshop, The Centre for Developmental Disability Health (www.cddh.monash.org) or online
through Melbourne University Bookshop (www.bookshop.unimelb.edu.au) for $25 (student price).
40
Moodle – Children’s Health
This is accessed via your “My Monash” portal
This site has many useful resources including lectures and workshop notes, digitised topics and
other web links, Paediatric surgical and radiology resources may also be found here.
Evidence Based Clinical Practice (EBCP), Health Systems & Management and Health Economics
modules will be predominantly Moodle based. You should allocate approximately 2 hours/week for
each of these. Modules are also available on floppy disc, CD and as hard copy. Please contact
your tutor if you are experiencing any difficulties.
Digitised Topics on Moodle
Family Interviewing & History Taking (chapter by Richard B Goldbloom)
Fever: Pathogenesis and treatment (chapter by Martin L Lorin)
Otitis Media (chapter by J Owen Hendley, M.D)
The Profession of Pediatrics (chapters 1-4 by Benjamin S. Siegel and Joel J. Alpert)
Useful Websites
Department of Paediatrics http://www.med.monash.edu.au/scs/paediatrics/
RCH Neonatal and Paediatric Guide: www.rch.org.au
Neonatal Emergency Transport Service Handbook http://www.netsvic.org.au/nets/handbook/
RCH Paediatric Practice Guidelines www.rch.org.au/clinicalguide/index.cfm?doc_id=5033
Medline plus http://www.nlm.nih.gov/medlineplus
Health for Kids in the South East: Guidelines and Clinical Paths asthma, bronchiolitis, croup and
diarrhoea http://www.southernhealth.org.au/page/Health_Professionals/CCE/Projects/HFK/
Malaysian Paediatric Association http://mpaweb.org.my
41

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Academic and Administrative Staff – Monash Medical Centre

Academic Teaching Administration

Professor Nick Freezer Mrs Lia Bretag

Associate Professor Michael Fahey Contact via administration staff

Academic Staff - Metropolitan Sites

Eastern Health Clinical School

Site Coordinator Site Administration

Box Hill Hospital

Site Coordinator Site Administration

Site Coordinator Site Administration

Site Coordinator Site Administration

Site Coordinator Site Administration

Site Coordinator Site Administration

Site Coordinator Site Administration

Gippsland Regional Clinical School

Site Coordinator Site Administration

East Gippsland Regional Clinical School

Site Coordinator Site Administration

Peninsula Clinical School

Site Coordinator Site Administration

Site Coordinator Site Administration

Mildura Regional Clinical School

Site Coordinator Site Administration

Clinical School Johor Bahru

Site Coordinator Site Administration

Workshop Week Lecture Program (Week 1)

Rotation 1.1 (Week 2 – 5) 18 February – 15 March

Rotation 1.2 (Week 6 – 9) 18 March – 12 April

Workshop Week Lecture Program (Week 10)

Rotation 1.3 (Week 11 – 14) 22 April – 17 May

Children’s Health Contemporary Issues – Group Presentations 15 March

Rotation 1.4 (Week 15 – 18) 20 May – 14 June

Children’s Health Semester 2

Workshop Week Lecture Program (Week 1) 8 July – 12 July

Rotation 2.1 (Week 2 – 5) 15 July – 9 August

Rotation 2.2 (Week 6 – 9) 12 August – 6 September

Workshop Week Lecture Program (Week 10)

Rotation 2.3 (Week 11 – 14) 16 September – 11 October

Children’s Health Contemporary Issues – Group Presentations 9 August

Rotation 2.4 (Week 15 – 18) 14 October – 8 November

END OF YEAR EXAMS

The main activities during your Children’s Health rotation are:

Attitudes and behaviour

Juvenile Chronic Arthritis R2 X X X X

Developmental delay disability R1

Aches & pains -

Juvenile Chronic Arthritis R2 X

Aches & pains -

Aches & pains

Developmental delay disability R1

Aches & pains

Assessment Task Due Date

In semester hurdle requirements:

In semester formative assessments

In semester summative assessments

A list of the clinical meetings for each department is also available.

The objectives of the clinical ward attachments are:

• To obtain real clinical experience in taking a history, performing an examination and

• To participate in medical and nursing procedures involving your patients

• To follow the progress of patients during the course of an admission

How to see patients on the paediatric wards at Monash

- You may be given permission immediately

3. Observed Clinical Examination (OCE)

4. Clinical Bedside Tutorials

Patient’s Presenting Problem _______________________ Sex M/F Age

Assessor’ Signature ___ Student’s Signature _