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Community Paediatrics


Dr. Mark Feldman - Section Head

Whenever possible, a child’s health care should be provided as close to home as possible by a family’s own physician. A greater and greater proportion of children, whose health issues do not require the specialized hospital services provided by SickKids, are now cared for by the paediatricians in their own communities. The Hospital for Sick Children plays an increasingly important role in the care of children with complex, tertiary health care needs.

In addition to paediatric care, medical education is thriving and indeed growing in community-based paediatric practice.

As of the start of the 2005 academic year, there were 96 community-based paediatricians from around the greater Toronto area who comprise the membership of the Section of Community Paediatrics within the University of Toronto.

Community paediatricians have been honored several times in the past few years at both the undergraduate and residency levels with teaching awards for which paediatricians from academic health science institutions compete alongside community-based paediatricians.

The growth of academic community paediatrics in Toronto in recent years has led to a critical need for a greater number of academic, community-based paediatricians. In addition to a need for service in community hospitals, there is a great need for more community-based teachers to train the greater number of medical students following recent increases in medical student enrollment.

A fellowship training program stream in community paediatrics has recently been developed. This fellowship was designed in part to develop teaching and research skills among residents destined for work in the community and in part to aid them by enhancing specific clinical skills necessary for acute care community-based hospital work.

History

Community Paediatrics is a Section of the University of Toronto, within the Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine. It is not a section of the Hospital for Sick Children, nor is it a section of the Child Health Network. The activities of its members however, compliment the work of the Hospital for Sick Children and its partners within the Child Health Network of Toronto. Moreover, leaders within the Hospital for Sick Children in their dual role as leaders within the University of Toronto, have guided, and continue to guide, the vision and  development of the Section of Community Paediatrics.

In the years preceding the development of the Section of Community Paediatrics, office-based paediatricians who were part-time staff at the Hospital for Sick Children cared for the children from their communities who were admitted to the Hospital for Sick Children.  It became clear that the complexity and acuity of medical problems [so called ‘weighted cases’] facing doctors at the Hospital for Sick Children was on the rise. Naturally the demands on care-givers’ time and skill increased [‘Resource Intensity Weighting’] (see Table 1). More and more, it became apparent that full-time hospital-based physicians would be required to care for these children.

While the beds at SickKids were increasingly filled by children with complicated health care needs, less complicated patients were increasingly referred back to be cared for closer to home within their communities. Thus office-based or community-hospital based paediatricians were needed less at SickKids and more within their own communities [see Table 2Table 3, and Table 4].

As the shift toward community-based care of children progressed, it followed that the most appropriate teaching cases also moved to community practices. Community hospital and office-based paediatricians had been playing a larger and larger role in the education of undergraduate and postgraduate medical trainees, offering a community-based experience and teaching about common and important problems facing our children’s health.

In order to recognize and promote the ongoing academic contributions made by community-based paediatricians, the Section of Community Paediatrics was created in 2000.

Education

Undergraduate Education

The majority of the undergraduate paediatric bed-side teaching takes place in community practice. Third year clerks may be assigned to office-based practices and/or to community hospitals.

The 2005 winner of the Lionel Weinstein Clerkship teaching award was Dr. Eddy Lau awarded on the basis of his office-based teaching as well as his teaching at St. Joseph’s Health Centre. The other nominees for this award were also all community-based paediatricians: Dr. Maggie Shu [North York General Hospital], Dr Shaheen Doctor [North York General Hospital], Dr. Doug Campbell [St. Michael’s Hospital] and Dr. Hartley Garfield [last year’s winner].

Section members regularly contribute to pre-clerkship teaching as well. In 2005, community paediatricians, Dr. Patricia Colangelo and Dr. Doug Campbell, were nominated for the R.H.A. Haslam pre-clerkship teaching award, which was won by Dr. Carolyn Calpin [SickKids].

Postgraduate Education

Residents in the first year of paediatric specialty training, ‘R1s’ now have a one-month, core rotation at either North York General Hospital or St. Joseph’s Health Centre. In addition, for second year residents, there are ambulatory rotations at St. Michael’s Hospitals. A rural elective experience at Orillia Soldier’s Hospital has become very popular among the senior residents. These community hospital experiences involve a mix of learning opportunities, including Level II newborn care, inpatient paediatric care, walk-in clinics, consultation clinics and community office practice. The 2005 Marvin Gerstein teaching award for part-timers at HSC, chosen by the paediatric residents, was won by Dr. Michael Peer. The runner-up was Dr. Norman Saunders. These two physicians not only practice at the SickKids, but also have thriving community-based paediatric practices in which they teach residents.

These residency rotations in the community not only provide some basic skills in common paediatric problem solving, but also introduce residents to the career option of community paediatrics.

The teaching of paediatrics to family medicine residents is also in the portfolio of community paediatricians within the Section of Community Paediatrics. Many community hospitals house family medicine residency training programs in which all of the specialties participate. Family medicine residents spend one month in paediatrics in each of their two years of training.

If a child is admitted to a community hospital, it is not uncommon to see five different trainees tagging behind the staff paediatrician on morning rounds [three students, one paediatric resident and one family practice resident]. Medical education really is thriving in our communities.

Community Paediatrics Fellowship

The Division of Pediatric Medicine offers a 24 month fellowship intended for individuals who have completed 3 or 4 years of Pediatrics and are preparing for a career in the setting of a Community Hospital. The individual will develop enhanced clinical expertise in the resuscitation and ongoing care of high risk neonates and children attending a community hospital. Individuals will be encouraged to undertake an independent research project. It is hoped that graduates of this fellowship will take a leadership role in their community hospital in the area of faculty development and in collaborative community-based paediatric research in concert with a Child Health Network.

Further information and applications for the Pediatric Medicine Clinical Fellowship or the Pediatric Medicine Academic Fellowship may be obtained from:

Dr. Patricia Parkin
Fellowship Director, Division of Pediatric Medicine
Hospital for Sick Children
555 University Avenue
Toronto, Ontario, Canada
M5G 1X8
Phone: 416-813-4175
FAX: 416-813-5663
e-mail: patricia.parkin@sickkids.ca

Community Paediatric Research

Research done by practicing community paediatricians presents a host of challenges. Given the shortage of community-based paediatricians, the clinical demands on a paediatricians time leads little for research. Moreover, the skill set of community-based paediatricians is highest for activities that absorb them; clinical care and teaching.

The obstacles to community paediatrician involvement in research notwithstanding, presented below is a recent sample of successful research in which community paediatricians were solely or heavily involved in the study design, implementation and write-up.

The 82nd Annual Meeting of the Canadian Paediatric Society Poster and Abstract Presentations

Severe neonatal hyperbilirubinemia in Canadian newborns: A preventable disease: DM Campbell, V Shah, M Sgro, St Michael's Hospital

Profiling children prenatally exposed to cocaine: A pilot study. BC Stade, L Bartholomew, T Barozzino, M Duarte, M Sgro, St Michael's Hospital.

Measuring sensory processing abilities in children with fetal alcohol spectrum disorder (FASD): A pilot study. BC Stade, L Bartholomew, M Duarte, T Sperling, M Sgro, J Zielonka, E Ying, D Campbell. St. Michael's Hospital

Multidisciplinary care guidelines promote positive outcomes in a Level 2 NICU. BC Stade, J Zielonka, K Buller, K Mcfadyen, E Wong, C Bishop, J Dockery, E Ying, St Michael's Hospital

Factors influencing infant feeding practices at an inner-city hospital in Toronto. E Tucker, V Kacinik, DM Campbell, K Janick, D McGovern, K Buller, P Darling, St Michael's Hospital

Do family physicians and paediatricians manage pharyngitis differently?
KC Danayan, C Chiu, R Mahtani, H Garfield, ME Feldman

Agreement between real-time visual analogue scale measurements and videotaped visual analogue scale measurements. M Ipp, L O'Brien, A Taddio, M Goldbach, G Koren

Aspiration prior to intramuscular vaccine injection: Is it necessary? Moshe Ipp MD, Jonathan Sam BSc, Patricia Parkin MD

Rounds and Continuing Education of Community Paediatricians

Much of the continuing education of Section members occurs at the community level with events including community hospital rounds and conferences. In addition the HSC reaches out with several CE events made available to community paediatricians, the largest event being the hospitals annual Paediatric Update. The Division of Paediatric Medicine contributes with the very successful and well attended ‘City Wide Rounds’ developed and hosted by two community paediatricians, Dr. Moshe Ipp and Dr. Norman Saunders. The Child Health Network contributes to physician and parent education through their websites PROFOR and Your Childs Health respetively. All 96 members of the Section of Community Paediatrics are invited to the Annual Section of Community Paediatrics Meeting, in part to enhance their skill in critical appraisal of journal articles an apply those skills to a ‘hot’ topic.

How To Contact Us:

Mark Feldman MD, FRCPC
Director, Section of Community Paediatrics, Division of Paediatric Medicine
Department of Paediatrics, Faculty of Medicine, University of Toronto
Email: mark.feldman@utoronto.ca

Address: The Hospital for Sick Children
Section of Community Paediatrics
Division of Paediatric Medicine
10th floor Black Wing
555 University Avenue, Toronto ON M5G 1X8

Daffodil Morrison, Team Leader
daffodil.morrison@sickkids.ca

Telephone: 416-813-7769
Fax: 416-813-5663




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