What makes a paediatric palliative medicine (PPM) paediatrician?
A paediatric palliative medicine (PPM) doctor has expertise working with neonates, infants, children and young people with life-limiting conditions and life-threatening illness, and their families. These conditions include malignancy; inherited disorders; cardiac, neurological and neuromuscular diseases; and a variety of rare progressive and irreversible conditions.
PPM doctors work alongside multidisciplinary teams (MDTs) across hospital, hospice and community settings, providing a total approach to care and focusing on quality of life. The approach embraces physical, emotional, social and spiritual elements. These consultants provide:
- specialist symptom management (eg nausea, pain, breathlessness, and agitation)
- guidance on advance care planning (eg the preferred place of care, and ceilings of care)
- guidance on end-of-life and bereavement care
- support with complex ethical decisions (eg feeding and hydration).
The PPM doctor also plays a vital role in supporting other healthcare professionals to care for children with life-limiting conditions.
RCPCH Progress curriculum and syllabi for level 3 training
Since August 2018, trainees in this sub-specialty use the RCPCH Progress level 3 generic syllabus alongside the RCPCH Progress paediatric palliative medicine sub-specialty syllabus. Download both documents below
In addition to the generic learning outcomes for level 3, PPM trainees must fulfil the following sub-specialty learning outcomes:
- Demonstrates specialist expertise in the management of life-threatening illness and life-limiting conditions across the paediatric spectrum, from the unborn baby, neonate and infant, to the child and young person.
- Works as a specialist expert in paediatric palliative medicine across a range of settings and within the MDT, by providing a holistic approach to care.
- Recognises, assesses, anticipates and manages the full range of symptoms experienced as disease and illness progress.
- Prescribes, reviews and monitors pharmacological treatment and non-pharmacological interventions necessary to manage patients with life-limiting illness, and at the end of life; ensures non-pharmacological interventions are integrated into care at all stages of management.
- Works together with patients, families and professionals to facilitate decision-making regarding planning and provision of care towards the end of life; ensures good practice and provides appropriate support and guidance in decision-making and advance care planning.
- Makes complex decisions and supports others making complex ethical decisions within the recognised UK framework.
- Demonstrates expertise on the physiological process and practical requirements of death and dying in childhood.
- Recognises grief and the need for bereavement care, including support for all family members and those who require specialist input.
- Recognises the impact of managing stressful, sensitive and often complex situations; the impact of multiple bereavements and the risk of burnout specific to palliative medicine; and the vulnerabilities of practitioners and colleagues.
- Works as a leader to improve evidence for, access to, and provision of paediatric palliative care.
- Possesses the procedural skills necessary to practise competently and effectively as a palliative care consultant, with the confidence to advise and support others.
Revised syllabus coming in August/September 2021
We spoke with clinicians working in this sub-specialty, and agreed some enhancements to the sub-specialty syllabus. The revised version is approved by the General Medical Council (GMC) for use as of August/September 2021. Download the revised syllabus below
Dr Jonathan Downie, Consultant in Paediatric Palliative Care, introduces the revisions to this sub-specialty's syllabus.
A summary of the changes:
- Learning Outcome (LO) 3 has been updated by adding the statement ‘considering their impact on physical, psychological and emotional health’.
- LO5 has also been updated by removing the statement ‘ensures good practice and provides appropriate support and guidance in decision-making and advance care planning’ and instead adding it as a new Key Capability (KC).
- LO8, KCs have been split into three separate KCs, and LO9 KCs have been split into two separate KCs.
- The Assessment Grid has been updated with changes made to the KCs.