Untitled Document
Guidelines for MD Paediatric Residents
II. Thesis works
Department will allot preceptor to each candidate at the end of first six month Residents should try to identify their own topic for the thesis within first year of their enrollment. The prepared protocol must be submitted to the department at the end of first year. They will be asked to present litterateur review, hypothesis, justification for the study, methods and materials and statistical methods to be used for the analysis for the result of their topics for the study.
It is compulsory that the thesis should be submitted to the Department before six months of the final examination. List of topics for thesis work is available in the department

They will start collecting data from the second year and data collections should be completed by the Ashwin of the second year. By Magh they should complete analysis and midterm presentation of the thesis work will be in Phalgun of the second year.

Please read the document “How to write a MD thesis” by DR. Pushpa Raj Sharma, available in Health Net Nepal under the topic Health resources "Thesis".

Final presentation, which includes results, discussions, limitations of the study and final recommendations will be done in Shrawan of the third year.

By Ashwin of the third year they should present six printed copies of their thesis work to the department, failure of this will lead to inability to appear in the final examination.

III. Presentations
Residents will be asked to take part in the following teaching learning activities of the department: topic presentation

a. journal club presentation
b. case presentation
c. bedside clinical presentation.

A faculty member will be available for their guidance. Residents are responsible to inform the faculty member well ahead of their presentation and take suggestions.
See attached list of topics for the presentations.

a. Journal club meeting
Residents should choose the journal article from the recent journals as far as possible for the presentation. Journals are available in the TUTH and departmental library. It is mandatory that they should use the facility of Internet, which is available free of cost in the department to find out the recent articles.
Residents should present the paper in the IMRaD format (Introduction, Methods, Results and Discussions). Suggested structures for the discussion of the journal article:

The following questions should be answered:

1. What were the study objectives?
· What were the study purpose and the scientific hypothesis to be tested?
· Is the objective clearly formulated?

2. What was the study about?
· How were the subject recruited?
· Describe the study site and study population: hospital or community
· What were the inclusion and exclusion criteria?

3. What was the design of the study?
· Describe the study design: randomised controlled trials; case control, prospective, retrospective etc.
· What specific interventions were considered, what was it compared with?
· What was measured and how?

4. How were the preliminary questions dealt with?
· Was the sample size or power calculation described?
· What is the duration of the follow-up?
· Completeness of the follow-up?
· Was the method of randomisation adequately described?

5. How did the author measure the outcome?
· Are primary and other outcomes clearly defined?
· Is a gold standard for outcome assessment described?

6. Quality control issues?
· How were the quality control and validation procedures
for the intervention and outcome assessment described?
· Was assessment blind?

7. Data analysis:
· What sort of data authors examining?
· Which statistical tests were done?
· Were the statistical tests were appropriate?
· Are the data analysed according to the original protocol?

8. Was systemic bias avoided or minimised?

9. Ethical issues:

· Are the ethical issues adequately described?

10. Conclusion and their use?
· Which were the generalizable conclusions: statistical significance or clinical .
· Are there new questions arising from the paper?
· Does this research as to the literature in any way?

For further guidance residents are asked to read the following articles available from Medline and library at TUTH:
1. Ad Hoc Working Group for Critical Appraisal of the Medical Literature. A proposal for more informative abstracts for clinical studies. Ann Intern Med 1987; 106: 598-604.
2. Reading the medical literature. In Princples and Practice of Pediatrics. Ed: Frank A. Oski. Second edition (1994). Page 24-29.

b. Topic presentation
A specific topic will be allotted to each resident depending upon his/her residency year as listed. The resident should present the topic within 45 minutes. Faculty member will guide the discussion after the presentation. At the beginning of topic presentation there well be MCQ test in important topics.

The resident should inform the faculty about the topic to be presented one week ahead of the presentation date. This presentation is not just delivering what is present in textbooks. The topic presentation should include the following:

a. review of the subject
b. report on research
c. provide practical instruction
d. provide supporting facts with adequate information and illustration.
e. Make reasonable conclusion from an interpretation of, his/her work, which is warranted by the information provided

C. Case presentation
The residents should ask the respective unit head for the type of cases to present. It should be informed to all the residents one/two day ahead of the presentations so that other will be able to review the cases before the day of presentation. During the presentation they should be able to show the transparency having following points:

- Age, address and presenting complaints.
- History
- Examination findings.
- Working diagnosis.
- Differential diagnosis
- Suggested investigations.
- Results of carried investigations.
- Final diagnosis.
- Summary of the disease.

Following reference is available at the departmental library:
James Calhan, Andras Barabas. Speaking at medical meetings: a practical guide. (Second edition).

D. Case of the month
This presentation consists of case presentation and definition, aetiology, epidemiology, pathophysiology, clinical features, differential diagnosis, treatment and prognosis of the case presented.
E. Problem solving
Each month one problem solving seminar will be held. Residents, house officers and interns are divided in different groups and each group will be led by the senior most resident. All groups will receive a simulated case history. Students will work in group and finally present the most likely diagnosis and plan of management
IV. Bhaktapur community paediatrics posting:
Residents will be posted once a week to Siddhi Memorial Mother and Child Hospital during their second year residency. They will visit different schools and the community satellite clinic of the Institute of Medicine. They should report to the Field Director and take active part in the following programs:

a. School health programs.
b. Adolescent health programs.
c. Community research

V. Ward work-up

Admission day:
1. Do quick ward round and attend OPD at 9.00 AM
2. Attend OPD cases.
3. Admit cases. Do not write history in the OPD but only necessary treatment and investigations. All admitted cases should be seen by senior resident of the unit.
4. Allot cases to interns to write history and supervise them
5. Attend the observation ward and sort out the cases.
6. Prepare the cases for the presentation to the consultant.

Post admission day:
1. Must know the working diagnosis of each patient.
2. Should give the evidence for their working diagnosis.
3. Should scientifically justify the treatment that has been provided.
4. Should give the plan for further investigations and treatment.

Third day:
1. All investigations as planned must be available. If it is not available he/should justify for the non-availability.
2. Case notes must be completed including detailed history, examination and plan of investigations.
3. Guardian of the patient must know the provisional/confirmatory diagnosis.
4. Guardian of the patient must know the home care of the disease the child is suffering from

All days:
1. Should check the daily follow-up notes Under the SOAP format if not complete should complete it.
2. Is responsible for the care provided under the unit head
3. Should be available in the hospital during the duty hours, except during the classes.
4. Should check the written discharge notes, sign and write own name in capitals.
5. Should supervise juniors on assigned activities.

VI. Internal assessments:

Internal assessments will be based on the observation of the work performances based on the evaluation form, this will be done by the head of the unit at the end of unit posting and two clinical bedside practical examinations. These practical examinations will be held at the end of first and second year. The formats of these examinations are very similar to the final examination.
VII. Log Book
Residents should maintain a log book in the following format and it must be signed by the consultant every month. This log book must be submitted to the department at the end of each posting.

Month…………Year………..Resident Name………………… …….. Consultant……………..

Date Procedures/activities
performed Signature of the consultant

VII. Evaluation
Residents should present the evaluation form to the unit head of the unit where they are working for the evaluation and submit the evaluated form to the Department .
VIII. Core Topics for the presentation by MD Residents
Core Topics For The MD Residents To Present In The Seminar
Topic Number First Year Second Year Third Year
1 Approach to a child with diarrhoea and vomiting Metabolic acidosis and alkalosis School Health
2 Approach to a child with abdominal pain Lung function test Adolescence Health
3 Approach to a child with hematemesis and melena Liver function tests Environmental issues in child health
4 Approach to a child with cough or difficulty in breathing Management of asthma Micronutrients in children
5 Approach to a child with stridor Investigating a child with collagen disease Disabled children in Nepal
6 Approach to a child with wheeze Approach to a child born to HIV mother Governmental and non governmental organizations of Nepal working for children
7 Approach to a child with cyanosis Breast feeding Parasitic infestations in children
8 Approach to a child with hepatosplenomegaly Nocturnal enuresis IMCI in Nepal
9 Approach to a child with pallor Assessment of growth Immunization in children
10 Approach to a child with haemorrhagic rash Asessment of development Childhood poisoning
11 Approach to a child with non haemorrhagic rash Diabetes mellitus Common psychiatric disorders
12 Approach to a child with joint pain Renal failure Common ENT diseases
13 Approach to a child with convulsion Disease of abnormal carbohydrate metabolism Common Eye problems
14 Approach to a child with cervical Disease of abnormal Common skin diseases
lymphadenopathy aminoacid metabolism
15 Approach to a child with pedal oedema Disease of abnormal fat metabolism Drowning and near drowning