Saudi Pediatric Infectious

Diseases Fellowship Curriculum

2020
 CONTRIBUTORS
Prepared and updated
Curriculum Scientific Group
Dr. Rana Hassan Almaghrabi
Dr. Omar Ahmed Alzomor
Dr. Ohoud Abdulrahman Alyabes
Dr. Fahad Hamad Aljobair
Dr. Esaam Al Banyan
Dr. Mohammed Al Shalaan
Dr. Mohammed Al Suihabani
Reviewed and approved
Contributors
Dr. Tariq Saleh Alfawaz
Dr. Abdulkarim Abdullah Al Rabiaah
Dr. Nora Ibrahim Alfattoh
Dr. Alaa Mohammed Aljuaid
Dr. Mubarak Alshamrani
Dr. Ohoud Abdulrahman Alyabes
Dr. Rana Hassan Almaghrabi
Approved by Head of Curricula Review Board
Dr. Ali Aseeri , MBBS, Msc.MedEd. FRCSC, FACS

The Pediatric Infectious Diseases Fellowship Program curriculum was initiated by previous infectious
diseases scientific committee groups and it has been recently prepared and updated by the current
Pediatric Infectious Diseases Scientific Group.

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 COPYRIGHT STATEMENTS

All rights reserved. © 2020 Saudi Commission for Health Specialties. This material may not be
reproduced, displayed, modified, distributed, or used in any other manner without prior written
permission of the Saudi Commission for Health Specialties, Riyadh, Kingdom of Saudi Arabia.
Any amendment to this document shall be endorsed by the Specialty Scientific Council and approved
by the Central Training Committee. This document shall be considered effective from the date the
updated electronic version of this curriculum was published on the commission’s website, unless a
different implementation date has been mentioned.
Correspondence:
Saudi Commission for Health Specialties
P.O. Box: 94656 Postal Code: 11614 Contact Center: 920019393
E-mail: [email protected]
Website: www.scfhs.org.sa

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 ACKNOWLEDGMENT

The Curriculum Scientific Group sincerely thanks the Pediatric Infectious Diseases Scientific
Committee and colleagues from all over the Kingdom who contributed to the development of this
curriculum, and highly appreciates their input, hard work, and commitment, without which this edition
would not have been possible.
Second, we would like to extend our sincere gratitude and appreciation to the previous scientific group
of the curriculum for their effort and excellent work. Part of this work was based on the previous
curriculum. Without their hard work and commitment, this edition would not have been possible.
Finally, the CSG would also like to thank the Medical Education Department of the Saudi Commission
for Health Specialties for their support and guidance.
Curriculum Scientific Group

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 TABLE OF CONTENTS

COPYRIGHT STATEMENTS 2
ACKNOWLEDGMENT 3
INTRODUCTION 7
1. Context of Practice 7
2. Goal and Responsibility of Curriculum Implementation 7
3. What is New in This Edition? 8
4. Policies and Procedures 9
5. Abbreviations Used in This Document 10
PROGRAM STRUCTURE 12
1. Program Entry Requirements 12
2. Program Durations 12
3. Program Rotations 13
Night Calls, Vacation, and Holidays 13
LEARNING AND COMPETENCIES 15
Introduction to Learning Outcomes and Competency-Based Education 15
THE INTRINSIC COMPETENCIES REQUIRED BY THE PEDIATRIC
INFECTIOUS DISEASES PROGRAM 19
1. Communicator 19
2. Collaborator 19
3. Manager 19
4. Health Advocate 20
5. Scholar 20
6. Professional 20
ACADEMIC ACTIVITIES 22
General Principles 22
Courses and Workshops 22
Universal Topics in Infectious Diseases 22
Module 1: Introduction 22
Module 2: Ethics and Healthcare 23

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ASSESSMENT OF LEARNING 25
1. Purpose of Assessment 25
2. Formative Assessment 25
3. Summative Assessment 28
CERTIFICATION OF TRAINING COMPLETION 30
RESOURCES 31
Suggested Textbooks 31
APPENDICES 32
Appendix A: Universal Topics 32
Appendix B: Infection Control Checklist 34
Appendix C: Infection Control Objective 35
SPECIFIC LEARNING OBJECTIVES: 35
STRUCTURE OF ROTATION 35
RESOURCES 36
Appendix D: Microbiology Checklist 37
Appendix E: Immunology Rotation 43
Appendix F: Formative Assessment 44
Appendix G: Promotion Written Examination Blueprint 45
Appendix H: Final Written Examination Blueprint Outlines 46
Appendix I: Final Clinical Examination Blueprint 47
Glossary 48

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 INTRODUCTION

1. Context of Practice
The Kingdom of Saudi Arabia is a rapidly developing country with significant improvements in health
services. Disorders caused by various infectious agents constitute one of the major causes of morbidity
and mortality in Saudi children. Furthermore, the field of infectious diseases is a rapidly progressing
subspecialty. Over the past two decades, there has been marked progress in diagnostic, preventive,
and therapeutic modalities. Furthermore, the list of newly discovered infectious agents and rapidly
changing disease syndromes as well as newly introduced antimicrobial agents is ever increasing.
Therefore, there is a growing demand for a national t r a i n i n g p r o g r a m t o provide pediatricians
with the necessary training in line with the Saudi Board in Pediatric Infectious Diseases. The
program s h o u l d h e l p trainees acquire competence in the management of various infectious
disease problems in infants, children, and adolescents and a c o m p r e h e n s i v e understanding
of the related social, economic, and environmental aspects.
Graduates of the pediatric fellowship program should be proficient in direct and consultative clinical
care, teaching, and/or a selected area of research. As a differentiation of interests and activities is
expected and encouraged, after completion of the program, fellows would continue to cultivate and
follow their area of interest in pediatric infectious diseases.
Training will also include the development of skills as an educator, including presentation skills,
curriculum development, and evaluation. In addition, fellows will receive foundational training in
research design, scientific writing, and literature review.

2. Goal and Responsibility of Curriculum Implementation

The program consists of two years of full-time structured supervised training in pediatric infectious
diseases. This will involve admission into an approved joint program with rotations in hospitals
accredited for training in pediatric infectious diseases.
The fellowship program offers an effective teaching curriculum for fellows to acquire the appropriate
medical expertise and decision-making skills to function as a practicing independent pediatric
infectious diseases consultant. This entails teaching in areas pertinent to the acquisition of medical
expertise and clinical decision-making skills, including clinical skills and bedside teaching. The
academic program includes organized teaching in the basic and clinical sciences relevant to pediatric
infectious diseases. An organized curriculum ensures that all major topics are covered over the course
of the fellow's time in the program. This includes teaching with a patient-centered focus and it may
include journal clubs, research conferences, and seminars, in addition to the use of an academic half-
day or its equivalent.
Fellows should be provided adequate protected time to attend the structured sessions, and attendance
is to be taken.
The program offers a broad range of clinical experiences. In addition to consultations in general and
subspecialty pediatric services, the program also offers consultations in the surgical subspecialties,
the oncology service, the pediatric and neonatal intensive care units, and the various transplantation
programs. Experience with adult infectious diseases is provided through rotations in an adult infectious
diseases training program or an organized adult infectious diseases service supervised by a qualified
adult infectious disease specialist.
Trainee fellows will have the opportunity to assume responsibility for patient care over a sufficiently
long period to observe the natural history of the disease and the benefits and complications of therapy.

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Organized outpatient clinics are available for the investigation and treatment of infections not requiring
hospitalization as well as for follow-ups of inpatients after discharge from the hospital.

3. What is New in This Edition?

A-Research Rotation: Fellows will learn how to develop a hypothesis from a thorough understanding
of existing data, develop specific aims to test that hypothesis, understand study design, develop an
appropriate protocol to accomplish the specific aims, analyze the data, and develop a manuscript to
communicate research findings by attending research courses.
Updates to the Pediatric Infectious Diseases program with the addition of research courses
(mandatory).
B-Pediatric Infectious Diseases Antimicrobial Stewardship as Mandatory Rotation (4 weeks)
Antimicrobial stewardship is a program that promotes the proper use of antimicrobials, including
antibiotics, improves patient outcomes, reduces microbial resistance, and decreases the spread of
infections caused by multidrug-resistant organisms.
Objectives:
1. Participate in the antimicrobial stewardship program rotation.
2. Actively participate in stewardship activities while on service (e.g., cover pager on weekdays, enter
stewardship notes, manage restricted antimicrobials for consult patients, and participate in
discussions of stewardship issues at conferences).
3. Cover the antimicrobial stewardship pager, managing issues such as approval requests, positive
blood culture alerts, drug level alerts, or multidrug-resistant organism alerts.
4. Attend weekly antimicrobial stewardship team meetings (pediatric and house-wide) and any other
relevant meetings.
5. Join the antimicrobial subcommittee and attend meetings.
6. Participate in the development of a treatment guideline.
7. Develop a research project relevant to antimicrobial stewardship.
8. Attend at least one antimicrobial stewardship conference during the fellowship.

C-Volunteering at Pediatric Infectious Diseases Mass Gathering Medicine (2 weeks)

Mass gatherings in Hajj and Umrah are associated with unique health risks such as transmission of
infectious diseases, particularly respiratory and gastrointestinal diseases (diarrheal disease), food
poisoning, hemorrhagic fevers, meningococcal diseases, cardiovascular disease, heat stroke, and
trauma.
Hajj presents a unique challenge that affects international public health. For this reason, we would like
to collaborate with the mass gathering medicine center by sending pediatric infectious diseases fellows
as volunteers.
A maximum of two weeks during the Hajj period in Mecca as part of the elective rotation.
The expected number is one fellow per year, starting 2021. This rotation was designed to provide the
Saudi healthcare system with qualified infectious disease professionals to cope with continuously
hosting such huge mass gathering events. The remaining 2 weeks of the rotation can be spent as
chosen by the fellows in the field, with activities such as Research.
Objectives: To improve their knowledge and skills in the following aspects:
– Potential risks for disease transmission.
– Involvement in vaccination campaigns and management of health hazards.
– Exposure to various infectious disease cases during the Al Hajj period (diagnosis and management).
– Infection control and preventive medicine during the Al Hajj period.
– Risk assessment and management.
– Surveillance and alert systems (Communicable disease surveillance).

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– Outbreak alert and response.
D-Infection Control and Prevention Rotation Checklist
To ensure that the fellows met the objectives of the infection prevention and control rotation after each
rotation. Please refer to Appendix B.
E-Microbiology Rotation Checklist
To ensure that the fellows met the objectives of the microbiology rotation after each rotation. Please
refer to Appendix D.
F-Universal Topics
These are interdisciplinary topics of the utmost importance to the trainee. These topics will be didactic
in nature, with a focus on practical aspects of care.
https://lms.scfhs.org.sa/course/index.php?categoryid=9%3EUniversal%20Topics
Assessment: The topics will be covered in a modular fashion. Each learning unit will end with an
online formative assessment. After all the topics are completed, there will be a combined summative
assessment in the form of context-rich MCQ. All trainees must attain minimum competency in the
summative assessment. Please refer to Appendix A.
G-Several tables have been added for ease of information retrieval.

4. Policies and Procedures

The pediatric infectious diseases fellowship program is aimed at producing competent specialists who
are able to manage infectious disease cases based on excellent medical evidence. In order to achieve
this, the program is designed to educate candidates in the relevant fields of the specialty. It is not a
didactic program. It is meant to be a self-training program with expert guidance. Candidates need to
build experience based on hands-on practice and self-education through different available teaching
resources. The following are general orientation points to help with rotations:
1. Most of the work of the infectious disease fellow is based on consultations from other services.
Therefore, when a consultation request is received, the fellow should read the consult and clarify
the question to be answered. In order to do so, the case should be reviewed thoroughly from all
aspects, not only the infectious disease aspect. As the patient should be seen and examined fully,
verbal consultation should be avoided as much as possible. After the clinical evaluation, the
findings should be documented in the consultation sheet and a plan of management including a
problem list, differential diagnosis, and suggested workup and intervention should be outlined. The
consultation question should be clearly answered, and if references are available, they should be
stated.
2. The fellow should try to review the online services briefly to try to reach the consultation answer
before discussing the case with his/her consultant.
3. Management plans should always be based on the most recent evidence and they should be
patient-centered rather than disease-centered.
4. The suggested management plan should be conveyed to the patient’s MRP or his/her designee
and should be discussed with the patient using age-appropriate language. Daily follow-up of the
patient is required until the infectious disease problem is resolved or the chronic care plan is
deemed clear.
5. The fellow is responsible for following up on all the pending laboratory investigations and making
any required changes based on the results, including antibiotic drug levels.
6. The fellow is responsible for communicating with microbiology, infection control, and other relevant
services if their assistance is needed.
7. Patients being followed by the Pediatric Infectious Disease Service are to be included in daily
rounds and notes on them are needed. Exceptions are those patients with chronic problems who
do not need daily rounds as agreed by the team.

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8. Weekend rounds are performed by the fellow covering the call for that weekend. The team
determines the patients that need to be seen prior to the start of the weekend. Weekends rounds
are to be completed everyday in the morning to ensure that the plan is set for the consulting service.
9. The pediatric infectious disease log should be filled out daily by the on-service fellow.
10. Each fellow should try to make a database of the interesting and educational cases that could be
potential case presentations, which all could benefit from, to be included in the portfolio.
11. The fellow should maintain a library of interesting pictures of patients, slides, culture media, and
other relevant data in the portfolio after obtaining consent from the patients/families as guided by
local regulations and practice.
12. Fellows should aim to fulfill the outlined objectives during their training and regularly review where
they stand with the program director or mentor.

General Objectives
The goal of the Infectious Diseases Program is to train pediatricians to:
1. Become competent in the management of infections in infants and children.
2. Acquire adequate basic science and clinical knowledge to be able to interpret data from the clinical
microbiology laboratory.
3. Become self-disciplined, self-dependent life-long learners, serve as consultants to other
services, and provide an educational environment that will promote a high standard of healthcare.
4. Perform research and emphasize the evidence-based approach to clinical problems.
5. Reach an internationally acceptable standard with appropriate attitude and medical ethics.
6. Understand the basics of infection control, epidemiology, and public health.
7. Gain knowledge of the pharmacology of antimicrobial agents used in pediatric patients.
8. Understand the basics of human defense against infections.

5. Abbreviations Used in This Document

SCFHS: Saudi Commission for Health Specialty.
ASP: Antimicrobial Stewardship Medicine.
MGM: mass gathering medicine.
HH: Hand hygiene.
HAI: Healthcare associated infection.
MRSA: Methicillin-resistant Staphylococcus aureus.
CLABSI: Central line-associated bloodstream infections.
VRE: Vancomycin-resistant enterococci.
IPass: Illness severity, patient summary, action list, situational awareness, and synthesis by the
receiver.
SBAR: Situation, background, assessment, and recommendation.
CDC: Centers for Disease Control and Prevention.
BSI: Blood stream infection.
VAP: Ventilator associated infection.
IP&C: Infection prevention and control.
SSI: Surgical site infection.
BMT: Bone marrow transplant.

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Non-BMT: Non-bone marrow transplant.

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 PROGRAM STRUCTURE

1. Program Entry Requirements

For admission into the Pediatric Infectious Diseases program, an individual must:
Possess a certificate from the Saudi Board of Pediatrics or an equivalent recognized degree, or
successfully complete the written component of the Final Saudi Board of Pediatrics.
1. Pass the interview conducted by the regional committee.
2. Provide three letters of recommendation from consultants with whom the candidate has recently
worked with for a minimum period of six months.
3. Provide written permission from the sponsoring institution of the candidate allowing him/her to
participate, on a full-time basis, for the entire duration of the program.
4. Register at the Saudi Council for Health Specialties for the program.

I. TRAINING CENTER REQUIREMENT

For any hospital to be accredited to participate in the Pediatric Infectious Diseases training program,
the following requirements must be fulfilled:
1. Full accreditation for pediatrics training by the Saudi Council for Health Specialties.
2. Qualified staff:
a) Program Director
The fellowship program director should be a pediatric infectious diseases consultant certified
by the Saudi Board of Pediatrics or its equivalent in general pediatrics. Additionally, the
director should preferably b e certified o r b e eligible for certification by an internationally
recognized scientific body in the field of pediatric infectious diseases, and have a minimum
of three years of post-training experience and a background in academia with an
understanding of research methodology.
b) A minimum of two full-time pediatric infectious diseases consultants (including a program
director) with at least two years of fellowship training in an accredited infectious diseases
program and at least three years of post- training experience.

3. Facilities and Resources.

The following are essential for the training program:
a) An adequate number of consultations involving immunocompetent and immunocompromised
children to ensure adequate exposure to infectious disease problems in various hosts. A record
of these consultations should be maintained.
b) In-patients and intensive care (including neonatal intensive care) and ambulatory care
facilities.
c) Fully equipped, high standard, and staffed microbiological laboratory facilities with the ability
to perform diagnostic bacteriology, parasitology, virology, mycology, and specialized
serological tests. This is in addition to a facility capable of performing diagnostic immunologic
and molecular tests.
d) Infection control services.
e) Supportive services such as diagnostic and interventional radiology and a pathology
laboratory.
f) Library facilities with ready access to all major infectious disease journals and literature search
facilities.

2. Program Durations
The Pediatric Infectious Diseases program is a two-year program during which the trainee rotates
through various rotations. These rotations include clinical services (12 months plus 1 month on the
adult service), microbiology (3 months), Antimicrobial Stewardship program rotation (1 month),

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infection control (2 months), clinical immunology (1 month), research (1 month), and an elective
rotation (1 month). The candidate is eligible for 4 weeks annual vacation.

3. Program Rotations
1. First Year
During the first year, the fellow is expected to:
a) Acquire a broad overview of t h e basic sciences of infectious diseases (e.g.,
microbiology, immunology, pathogenesis, and pharmacology).
b) Gain adequate knowledge of common pediatric infectious disease problems.
c) Have the following supervised rotations (mandatory):
Consultation Service (minimum). 7 months
General Microbiology. 4 weeks
Parasitology Virology-Molecular, serology. 2 weeks
Tuberculosis/Mycology. 2 weeks

The rest of the first year will be left for the program director to assign the fellow any approved
rotation of the program, for example:

Mandatory
Rotations F1
Consultation Service 7 months
Microbiology 2 months
Immunology 1 month
Infection control 1 month
Annual leave
Annual leave 4 weeks

2. Second Year
During the second year, the fellow is expected to:
a) Acquire a high level of understanding of the basic sciences and their application to the
management of infectious disease problems.
b) Learn the approach to investigate and manage complicated and rare infectious diseases.

During this year, the trainee will have a month of training in the microbiology laboratory. The fellow
will also complete the rest of the rotations that were not completed during the first year. The elective
rotation may be spent in tropical medicine or other areas of infectious diseases deemed acceptable
by the program. Covering the Hajj duty would also qualify as part of the elective experience, for
example:

Mandatory
Rotations F2
Consultation in pediatric 3 months
infectious diseases service
Consultation service with 2 months
pediatric
immunocompromised
patients
Consultation in adult 1 month
infectious diseases service

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 Microbiology 1 month
Antimicrobial Stewardship 1 month
Program
Infection control 1 month
Research 1 month

Elective
Elective 1 month
Annual leave
Annual leave 4 weeks

Night Calls, Vacation, and Holidays

a) Trainees are required to take calls for the Infectious Disease Service for a maximum of two weeks
per month, including two weekends.
b) Fellows are entitled to four weeks of annual vacation and a maximum of ten days for both Eid and
emergency leave. Additionally, they should always follow the updated SCFHS rules and
regulations on leaves.
c) Sick and maternity leaves should be compensated for during training or at the end of it, and they
will always follow the updated SCFHS rules and regulations on leaves.

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 LEARNING AND COMPETENCIES

Introduction to Learning Outcomes and Competency-Based Education

Trainees should acquire competence in the following areas:

Medical Expertise
The fellow should acquire knowledge and skills in the following areas during the clinical rotations:
Etiology, pathogenesis, natural history, pathology, clinical picture, and management of the following:
1. Acute illnesses due to various microbial agents, including acute communicable diseases
occurring in normal hosts due to important:
a. Bacterial pathogens including Mycobacterial disease.
b. Fungal agents.
c. Viral pathogens.
d. Tropical and parasitic diseases, particularly malaria, leishmaniasis, and schistosomiasis.
2. Fever and inflammatory response.
3. Systemic inflammatory response syndrome, sepsis, and septic shock.
4. Hemophagocytic lymphohistiocytosis and macrophage activating syndrome.
5. Fever without a focus:
a. Fever without localizing signs.
b. Fever of unknown origin.
6. Focal and generalized lymphadenopathy.
7. Ear, nose, and throat infections:
a. Pharyngitis.
b. Oral cavity infections.
c. Otitis media and otitis externa.
d. Sinusitis.
e. Mastoiditis.
8. Cardiac and vascular infections:
a. Endocarditis and other intravascular infections.
b. Myocarditis.
c. Pericarditis.
9. Respiratory tract infections:
a. Bronchiolitis.
b. Acute pneumonia and its complications.
c. Pneumonia in immunocompromised host.
10. Central nervous system infections:
a. Acute bacterial meningitis.
b. Chronic meningitis.
c. Aseptic and viral meningitis.
d. Encephalitis.
e. Para- and post-infectious neurologic syndromes.
f. Focal suppurative infections of the nervous system.
g. Eosinophilic meningitis.
h. Prion diseases.
11. Genitourinary tract infections:
a. Urinary tract infections.
b. Renal abscess and other complex renal infections.
c. Urethritis, vulvovaginitis, and cervicitis.
d. Pelvic inflammatory disease.
e. Epididymitis, orchitis, and prostatitis.
f. Sexually transmitted infectious syndromes.
g. Infectious diseases in child abuse.
12. Gastrointestinal and intra-abdominal infections:

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 a. Viral gastroenteritis.
b. Inflammatory enteritis.
c. Enteric diseases transmitted through food, water, and zoonotic exposure.
d. Necrotizing enterocolitis.
e. Acute hepatitis.
f. Chronic hepatitis.
g. Granulomatous hepatitis.
h. Acute pancreatitis.
i. Cholecystitis and cholangitis.
j. Peritonitis.
k. Appendicitis.
l. Intraabdominal, visceral, and retroperitoneal abscesses.
13. Skin & soft-tissue, bone & joint infections:
a. Superficial bacterial skin infections and cellulitis.
b. Erythematous macules and papules.
c. Vesicles and bullae.
d. Purpura.
e. Urticaria and erythema multiforme.
f. Papules, nodules, and ulcers.
g. Subcutaneous tissue infections and abscesses.
h. Myositis, pyomyositis, and necrotizing fasciitis.
i. Osteomyelitis.
j. Infectious and inflammatory arthritis.
k. Diskitis.
l. Transient synovitis.
14. Ophthalmologic infections:
a. Conjunctivitis.
b. Infective keratitis.
c. Uveitis, retinitis, and chorioretinitis.
d. Endophthalmitis.
e. Periorbital and orbital cellulitis.
15. Infections following trauma.
16. Infections following burns.
17. Infections following bites.
18. Infections related to pets and exotic animals.
19. Tick-borne infections.
20. Nosocomial infections.
21. Infections in immunocompromised h o st ( c o ng e n i t a l a n d a c q u i r e d ) , including patients with
acquired immunodeficiency syndrome (AIDS), burn patients, and organ transplant
recipients.
22. Intrauterine and neonatal infections including congenital infections.
23. Infections associated with medical devices and prosthetics.
24. Infections in children with inborn errors of metabolism, genetics, and other systemic disorders.
25. Surgical and OB/GYN infections.
26. Zoonosis.
27. Infections related to travel.

The fellow should recognize and acquire knowledge and skills in the following areas during the
microbiology rotations:
General knowledge and technical skills in all principal areas of diagnostic microbiology,
virology, and parasitology, including knowledge of appropriate diagnostic material f or most
diseases or syndromes, and the ability to differentiate normal flora from pathological organisms.
(See attached detailed Microbiology Objectives).
Trainees will spend 4 months full-time with diagnostic microbiology and molecular techniques under

16
the supervision of a certified microbiologist i n an accredited laboratory for training in medical
microbiology.
The following areas of laboratory training are considered essential:
1. General Microbiology:
a. Routine techniques including the use of different culture media, specimen collection and
primary inoculation, and various staining techniques.
b. Bench experience and familiarity with special isolation and identification techniques related
to urine, respiratory, blood, tissue, and body fluids, and enteric and anaerobic bacteriology.
c. Antibiotic susceptibility testing and assays for antibiotic levels.
2. TB/Fungi and Parasitology:
a. Specimen collection, transport, media for fungi, and mycobacteriology.
b. AFB staining and antibiotic sensitivity testing for mycobacteria.
c. Identification of common fungi including Candida, Aspergillus, and Cryptococcus, and
fungal serology and antigen detection.
d. Stool examination for ova, trophozoites, and larvae; concentration techniques; string test;
special stains and serology.
3. Virology, mycoplasma, and chlamydia:
a. Virus isolation for herpes viruses, respiratory viruses, and enteric viruses.
b. Viral serology including EBV, hepatitis, HIV, measles, and rubella.
c. Chlamydia and mycoplasma isolation and antigen detection systems.
d. Special techniques - Quantitative bacteriology, rapid diagnostic techniques, ELISA,
immunofluorescence, DNA probes, electron microscopy, etc.
4. Special Techniques:
a. Quantitative bacteriology, rapid diagnostic techniques, ELISA, immunofluorescence, DNA
probes, and electron microscopy.

The fellow should recognize and acquire knowledge and skills in the following areas during the
infection control rotations:
Infection Control and Nosocomial Pathogens (See Appendix C for a detailed description of the
rotation).
1. Role of the microbiology laboratory in infection control and surveillance.
2. Infection control unit’s organization and function.
3. Epidemiology and laboratory investigation of nosocomial outbreaks, including bio typing, phage
typing, and plasmid analysis.
4. Hospital Acquired infections: (SCFHS Universal Topic)
a. Discuss the epidemiology of HAI with special reference to HAI in Saudi Arabia.
b. Recognize HAI as one of the major emerging threats in healthcare.
c. Identify the common sources and set-ups of HAI.
d. Describe the risk factors of common HAI such as ventilator-associated pneumonia, MRSA,
CLABSI, and vancomycin-resistant Enterococcus (VRE).
e. Identify the role of healthcare workers in the prevention of HAI.
f. Determine appropriate pharmacological (e.g., selected antibiotic) and non-pharmacological
(e.g., removal of indwelling catheter) measures in the treatment of HAI.
g. Propose a plan to prevent HAI in the workplace.

The fellow should recognize and acquire knowledge and skills in the following areas during the
immunology rotations:
Knowledge of immunology and immunization practices, including: (see Appendix E for detailed
Immunology rotation objectives).
1. Details of humoral, cell-mediated, and phagocytic responses to microbial colonization and
invasion in normal a n d abnormal hosts.

17
2. Pathogenic mechanisms by which immune response facilitates or prevents diseases.
3. Principles and practice of immunization techniques together with the adverse effects and
efficacy of immunizing agents.

The fellow should recognize and acquire knowledge and skills in the following areas during the
Antibiotic Stewardship program rotation:
1. Recognize antibiotic resistance as one of the most pressing global public health threats.
2. Describe the mechanism of antibiotic resistance.
3. Determine the appropriate and inappropriate use of antibiotics.
4. Develop a plan for safe and proper antibiotic usage, including right indications, duration, types
of antibiotics, and discontinuation.
5. Be apprised of the local guidelines in the prevention of antibiotic resistance.
6. Knowledge of antimicrobial pharmacology to include:
a) Classification of antimicrobial agents.
b) Pharmacokinetics in normal and abnormal hosts.
c) Mechanism of action and resistance.
d) Toxicity and drug interaction.
e) Transplacental transfer and potential effects on the fetus.
f) Transfer by breast- feeding.

This will be taught through several sessions on the topic, along with case-based discussions. The
fellow will also have the opportunity to contribute to the antibiotic stewardship program through the
IPC rotation, clinical rotation, or elective rotation, and document this in their portfolio.

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 THE INTRINSIC COMPETENCIES REQUIRED BY THE PEDIATRIC
INFECTIOUS DISEASES PROGRAM

1. Communicator
The program ensures adequate structured teaching of skills for oral communication between fellows
and a variety of other individuals encountered in the specialty to enable fellows to effectively:
a) Interact with patients and their families, colleagues, students, and co-workers from other disciplines
to develop a shared plan of care.
b) Describe to the patient/parents the diagnosis and to communicate the plan of care to them in an
understandable and appropriate manner.
c) Write patient records and utilize an electronic medical record when available.
d) Write medical reports and letters of consultation or referral when needed.
e) Deal with patients and family with compassion and in a culturally sensitive manner.
f) Incorporate the principles of appropriate disclosure of patient safety incidents: (SCFHS Universal
Topic)
1. Know which incidents require disclosure and what the threshold is for disclosure to patients.
2. Use a framework to disclose incidents to the patient.

2. Collaborator
The program will teach and develop collaborative skills related to pediatric infectious diseases to
enable fellows to:
a) Work effectively with all members of the interprofessional healthcare team, including other
physicians and health professionals.
b) Prepare, organize, and moderate multidisciplinary team meetings and to summarize outcomes to
provide optimal comprehensive patient care.
c) Learn skills for requesting and providing consultations, including the appropriate completion of
consultation forms.
d) Manage conflict.
e) Prepare a consultation reply template.
1. Express thanks for consults.
2. Summarize the reason for the consult in one to two lines (We consulted on a 2-year-old with a
coagulase-negative staphylococcus ventriculoperitoneal shunt infection).
3. Brief list of underlying/chronic problems.
4. History focused on infectious disease.
5. Targeted infectious disease PMH, travel history, vaccine history FH, and social history if
needed (avoiding a laundry list of negatives).
6. Focused physical exam.
7. Summary of infectious disease issue with limited and logical differential diagnosis.
8. Recommendations based on differential diagnosis.
9. Someone from the consulting team must be contacted and given a summary of the above.
f) Apply a structured method of handover at various points of transfer of service, such as IPass or
SBAR (SCFHS Universal Topic).

3. Manager
The program will ensure that fellows participate in activities that contribute to the effective management
and administration of their healthcare organizations and systems.
a) Fellows should be able to demonstrate effective allocation of finite healthcare resources.
b) Fellows should be able to understand how to manage their practice and career plans.
c) The program will provide opportunities for fellows to serve in administration and leadership roles,
based on the discipline.

19
d) Fellows will be responsible for managing team rounds that may include students, residents, and
other medical personnel.

4. Health Advocate
The program will ensure that fellows are able to understand and promote the health of individual
patients, communities, and populations.
a) Fellows should be able to identify and understand the health needs and priority infectious diseases
of the communities they serve.
b) Fellows should be able to identify risk factors related to pediatric infectious diseases and know how
to intervene.
c) Fellows should be able to identify advocacy issues within the specialty for individuals, communities,
and populations, such as, but not limited to:
1. Vaccine awareness, promotion, and side effects, and how to respond to misinformation
regarding routine, seasonal, and special vaccines.
2. Zoonotic infections and their prevention.
3. Outbreak control.
d) Fellows should be able to respond to individual patient health needs and issues as part of patient
care and advocate for their patients with other services and specialties.

5. Scholar
The program will ensure that opportunities are provided for fellows to develop effective teaching skills
by teaching colleagues and students, as well as through seminar or conference presentations, clinical
and scientific reports, and patient education.
a) Fellows should acquire the skills needed for the critical appraisal of medical literature using
knowledge of research methodology and biostatistics.
b) The fellow will acquire skills in self-assessment and self-directed life-long learning.
c) The fellow should be able to conduct a scholarly project.
d) Teaching Responsibilities: The fellows will be provided the opportunity to develop effective
teaching skills. This will be achieved through daily rounds and informal group discussions in
addition to formal teaching sessions and via written consultation reports.
e) Research: Fellows are expected t o participate in the research activities of the pediatric
infectious diseases section, and by the end of the training period, they should complete
one research project, prepare and submit at least one manuscript to a refereed journal, a n d / or
present a paper in a local or international scientific meeting. Acceptable research projects may
include the following:
1. Analysis of a contemporary clinical problem involving human subjects, using acceptable
statistical methods as required. The results of this analysis are to be reported at local or
national meetings, and should be eligible for publication in scientific journals.
2. Supervised participation in an ongoing project in experimental medicine.
3. Quality assurance study of clinical practice.
4. Study in medical education.
5. Other proposals accepted by the program.

6. Professional
The program will ensure effective teaching in appropriate professional conduct and ethical behaviors
so that fellows are able to:
a) Deliver the highest quality care with integrity, honesty, compassion, and confidentiality.
b) Exhibit appropriate professional and interpersonal behaviors.
c) Practice medicine in an ethically responsible manner.
d) Understand the basic principles and practice of bioethics as it relates to their specific clinical
discipline.

20
e) Acquire knowledge of the relevant Saudi legislation and regulations to guide their practice in their
specific discipline.
f) Be aware of the importance of physician health and well-being and its importance in the
development of a sustainable practice.
g) Identify and apply the elements of patient safety culture (SCFHS Universal Topic).

21
 ACADEMIC ACTIVITIES

General Principles
a) Teaching should contain both:
i. A structured-programmatic component
ii. A practice-based component
b) Efforts should be directed to enhance fellows’ responsibility toward self-directed learning.
c) Every week, at least 2–4 hours of formal training time (commonly referred to as an academic half-
day) should be reserved. “Formal teaching time” is an activity that is planned, with an assigned
tutor, time slots, and venue. Formal teaching time excludes bedside teaching, clinic posting, etc.
(40 sessions per year).
d) Formal training time should be supplemented by other practice-based learning (PBL) activities such
as:
i. Morning report of case presentations
ii. Morbidity and mortality reviews
iii. Journal clubs
iv. Grand rounds
v. Regional citywide activity and pediatric infectious disease academic activity
vi. Continuous professional activities (CPD) relevant to specialty
e) Fellows should assign at least 1 hour periodically to meet with their mentors, in order to review
performance reports (e.g., ITER, e-portfolio)

Courses and Workshops

1. Fellows should attend research courses (mandatory)
2. Fellows are encouraged to participate in community activities (volunteer)

Universal Topics in Infectious Diseases

Background
Universal Topics were developed as learning resources for fellows. These are important topics for
fellows because they are either very common and deal with important clinical conditions, or they are
not taught effectively in many medical schools. https://lms.scfhs.org.sa/course/index.php?
categoryid=9%3EUniversal%20Topics
The assigned topics should be completed within the allocated year. Trainees and mentors should take
personal initiatives to complete universal topics on time.
The fellow will have the opportunity to contribute to the antibiotic stewardship program and the hospital
acquired infections program (Modules 1 and 2) through the IPC rotation, clinical rotation, or elective
rotation in F1 and F2, with documentation in their portfolio. This can be executed either year, but the
fellow does not graduate until he/she completes both.
– Refer to appendix A.

Module 1: Introduction
1. Safe drug prescribing
2. Hospital acquired infections
3. Sepsis, SIRS, and DIVC
4. Antibiotic stewardship

Safe Drug Prescribing: At the end of the learning unit, you should be able to:
a) Recognize the importance of safe drug prescribing in healthcare.
b) Describe the various adverse drug reactions with examples of commonly prescribed drugs that can
cause such reactions.

22
c) Apply principles of drug-drug interactions, drug-disease interactions, and drug-food interactions in
common situations.
d) Apply principles of prescribing drugs in special situations such as renal failure and liver failure.
e) Apply principles of prescribing drugs for elderly and pediatric age patients, and during pregnancy
and lactation.
f) Promote evidence-based cost-effective prescribing.
g) Discuss the ethical and legal frameworks governing safe drug prescribing in Saudi Arabia.

Hospital Acquired Infections (HAI): At the end of the learning unit, you should be able to:
a) Discuss the epidemiology of HAI with special reference to HAI in Saudi Arabia.
b) Recognize HAI as one of the major emerging threats in healthcare.
c) Identify the common sources and set-ups of HAI.
d) Describe the risk factors of common HAIs such as ventilator-associated pneumonia, MRSA,
CLABSI, and vancomycin-resistant Enterococcus (VRE).
e) Identify the role of healthcare workers in the prevention of HAI.
f) Determine appropriate pharmacological (e.g., selected antibiotic) and non-pharmacological (e.g.,
removal of indwelling catheter) measures in the treatment of HAI.
g) Propose a plan to prevent HAI in the workplace.

Sepsis, SIRS, and DIVC: At the end of the learning unit, you should be able to:
a) Explain the pathogenesis of sepsis, SIRS, and DIVC.
b) Identify patient-related and non-patient-related predisposing factors of sepsis, SIRS, and DIVC.
c) Recognize a patient at risk of developing sepsis, SIRS, and DIVC.
d) Describe the complications of sepsis, SIRS, and DIVC.
e) Apply the principles of management of patients with sepsis, SIRS, and DIVC.
f) Describe the prognosis of sepsis, SIRS, and DIVC.

Antibiotic Stewardship: At the end of the learning unit, you should be able to:
a) Recognize antibiotic resistance as one of the most pressing global public health threats.
b) Describe the mechanism of antibiotic resistance.
c) Determine the appropriate and inappropriate use of antibiotics.
d) Develop a plan for safe and proper antibiotic usage, including right indications, duration, types of
antibiotics, and discontinuation.
e) Be apprised of the local guidelines in the prevention of antibiotic resistance.

Module 2: Ethics and Healthcare

1. Occupational hazards of HCW.
2. Patient advocacy.
3. Ethical issues: treatment refusal, patient autonomy.
4. Role of doctors in death and dying.

Occupation Hazards of Healthcare Workers (HCW): At the end of the learning unit, you should be
able to:
a) Recognize common sources and risk factors of occupational hazards among HCW.
b) Describe common occupational hazards in the workplace.
c) Develop familiarity with legal and regulatory frameworks governing occupational hazards among
HCW.
d) Develop a proactive attitude to promote workplace safety.
e) Protect yourself and colleagues from potential occupational hazards in the workplace.

23
Patient Advocacy: At the end of the learning unit, you should be able to:
a) Define patient advocacy.
b) Recognize patient advocacy as a core value governing medical practice.
c) Describe the role of patient advocates in the care of patients.
d) Develop a positive attitude toward patient advocacy.
e) Be a patient advocate in conflicting situations.
f) Be familiar with local and national patient advocacy groups.

Ethical issues: treatment refusal, patient autonomy: At the end of the learning unit, you should be
able to:
a) Predict situations where a patient or family is likely to decline prescribed treatment.
b) Describe the concept of “rational adult” in the context of patient autonomy and treatment refusal.
c) Analyze key ethical, moral, and regulatory dilemmas in treatment refusal.
d) Recognize the importance of patient autonomy in the decision-making process.
e) Counsel patients and families declining medical treatment in light of the best interest of the patient.

Role of Doctors in Death and Dying: At the end of the learning unit, you should be able to:
a) Recognize the important role a doctor can play during the dying process.
b) Provide emotional as well as physical care to a dying patient and his/her family.
c) Provide appropriate pain management to a dying patient.
d) Identify suitable patients and refer the patient to palliative care services.

F1 F2
Module Module
Module 1: Introduction Module 1: Introduction
1. Safe drug prescribing 1. Safe drug prescribing
2. Hospital acquired infections 2. Hospital acquired infections
3. Sepsis, SIRS, and DIVC 3. Sepsis, SIRS, and DIVC
4. Antibiotic stewardship 4. Antibiotic stewardship
Module 2: Ethics and Healthcare Module 2: Ethics and Healthcare
1. Occupational hazards of HCW 1. Occupational hazards of HCW
2. Patient advocacy 2. Patient advocacy
3. Ethical issues: treatment refusal, patient 3. Ethical issues: treatment refusal, patient
autonomy autonomy
4. Role of doctors in death and dying 4. Role of doctors in death and dying

The fellow will not graduate until he/she completes these modules if they are not completed during
his/her residency.

24
 ASSESSMENT OF LEARNING

1. Purpose of Assessment
Assessment plays a vital role in the success of postgraduate training. Assessment guides trainees and
trainers in achieving the targeted learning objectives. Moreover, reliable and valid assessment
provides an excellent means of training improvement as it informs the following aspects: curriculum
development, teaching methods, and quality of learning environment. Assessment can serve the
following purposes:
a) Assessment for learning: As trainers use information from trainees’ performance to inform their
learning for improvement.
b) Assessment as learning: As assessment criteria drive trainees’ learning.
c) Assessment of learning: As assessment outcomes represent quality metrics that can improve
learning experience.

For the sake of organization, assessment will be further classified into two main categories: Formative
and Summative.

2. Formative Assessment
SAUDI PEDIATRIC INFECTIOUS DISEASES FELLOWSHIP TRAINING PROGRAM Promotion
Examination
Written Examination Format:
 A written examination shall consist of one paper with not less than 100 MCQs with a single best
answer (one correct answer out of four options).
 The examination shall contain type K2 (interpretation, analysis, reasoning, and decision-making)
and type K1 (recall and comprehension) questions.
 The examination shall include basic concepts and clinical topics relevant to the specialty.
 Clinical presentation questions include history, clinical findings, and patient approach. Diagnosis
and investigation questions include possible diagnosis and diagnostic methods. Management
questions include treatment and clinical management, either therapeutic or non-therapeutic, and
complications of management. Materials and Instruments questions include material properties,
usage, selection of instruments, and equipment used. Health maintenance questions include health
promotion, disease prevention, risk factor assessment, and prognosis.

The trainee's performance is assessed in each of the evaluation formulas according to the following
scoring system:

To upgrade from the training level to the next level, the trainee must obtain at least a Borderline Pass
result in each evaluation form.
The program director may recommend to the local supervision committee to request the promotion of
a trainee who did not meet the previous promotion requirement based on the following:
1. If the trainee gets a Borderline Fail result in one of the evaluation forms, the remaining evaluation
forms must be passed with Clear Pass in at least one of them.
2. When the trainee gets a Borderline Fail result in a maximum of two of the evaluation forms, provided
they do not fall under the same theme, for example, knowledge, attitude, and skills, the remaining
evaluation forms must be passed with Clear Pass in at least two of them.
3. In this case, the promotion must be approved by the Scientific Council for the specialization.

25
F1 (First year) to F2 (Second year):
According to SCFHS rules and regulations regarding the promotion of fellows from F1 to F2 (included
in fellows’ package and on the SCFHS website), fellows must be assessed in the three areas of:
Knowledge (‫)المعرفة‬, Skills (‫)المهارة‬, and Attitude (‫)السلوك‬

using different tools. Each tool will be assessed using a system of:

Clear Pass CP, Borderline Pass BP, Borderline Fail BF, and Clear Fail CF.
The F1 candidate must achieve at least BP in all tools to be promoted.
The F2 candidate must achieve at least BP in all continuous assessment tools to attend the final
certification examination.
Please see the detailed description in SCFHS.

‫ التقويم المستمر والترقية السنوي‬،‫سلسلة القواعد التنفيذية للتدريب‬

The tools determined by the Pediatric Infectious Diseases Scientific Committee are:
KNOWLEDGE:‫المعرفة‬

1. Written Promotion Examination (for F1): A final written examination composed of 80–100 MCQs
and/or a number of short answer questions to be administered before the end of the first year.
2. Academic half-days (4 topic/case presentations per year are required) and a journal club (at least
3 per year).
3. Knowledge-based academic activities (Required for F1 and F2): The fellow will be required to
answer MCQs, a total of 15 MCQs (quizzes), which will be discussed to ensure proper feedback
and progress. This will be with a brief correct answer vignette and 2–3 references. Fellows will
receive material and orientation on Item Writing in the first month of training.

SKILLS ‫المهارة‬:

1. Research ‫( نشاط بحثي‬Required for F1 and F2): Research requirements of the SCFHS Pediatric
Infectious Diseases Fellowship Program:
 F1 candidates are required to submit an official pediatric ID and an institutionally approved
proposal by the end of November to receive either Clear Pass (CP) or Borderline Pass (BP),
depending on the quality, originality, and complexity of design.
 F2 must submit a complete manuscript ready for publication by the end of the program to
receive a CP or BP based on quality, originality, and complexity of design.

Accepted Research Projects:

 Accepted single fellow projects include case Series with review and descriptive retrospective
reviews, for example: “All cases of brucellosis from 2010 to 2019 were reviewed ...”
 Accepted single or shared fellow projects include hypothesis-driven studies that include a sample
size of at least 100, such as patient questionnaire-based cross-sectional studies.
 Case control studies.
 Retrospective and prospective cohort studies.

Case reports, while highly encouraged because they are an excellent way of getting started in research
and practicing academic writing and responding to editors, do not meet the research requirement for
F1 promotion, or for attending the final certification examination for F2.

26
We encourage fellows to select a supervisor (who may be from outside the pediatric ID division, for
example, from microbiology, pharmacology, or pathology) and topic within the first 3 months of the
program in order to have sufficient time to complete requirements before the end of the year.
2. Portfolio (Required for F1 and F2):
 Should have chapters or tabs.
 Each entry will require a brief ~ 150-250-word reflection on what was learned.
 Should be electronic.
 Chapters/Folders:

1. Rotations:
Titled based on that month’s rotation, i.e., "Clinical at KAMC," "LAB," "Infection Control,” etc.
Describe briefly:
 2-3 interesting cases.
 List what was newly learned from these cases.
 Diagnostic challenges.
 Ethical issues of a case, for example.
 Describe management issues, such as dealing with the residents, dealing with telephone
consults, and night calls.
 For example, what was newly learned in infection control? Can it be applied to your institution,
and what are the difficulties that may arise in trying to implement them?
 It is the same for "LAB" or "Adult rotations." Each will have a section in the "Rotations" chapter.
 Reflections on quality of rotation and how it can be improved.
2. Case/topic presentations that are formally assessed with the evaluation form. Four are required per
year:
Insert full PowerPoint presentations in portfolio.
3. Journal Club (at least 3 per year):
Insert chosen articles and summary of critical review, such as PICO.
4. Insert any other academic activities:
 Document and summarize local or international conferences that were attended.
 Document and briefly summarize other conferences or workshops that were attended, such
as Introduction to Clinical Research and Statistics.
5. Any other activities or projects such as:
 Infection control or Audit/Quality improvement projects or activities
 Membership in committees. Describe how these committees’ function, their benefits and
difficulties, whether they could be utilized in your institution of other models, etc.

ATTITUDE ‫سلوك‬:

The assessment tool for this competency will be assessed by the monthly ITER using various daily
direct observations, case discussions, or other tools as needed.

Pediatric infectious diseases assessment tools:

Knowledge Skill Attitude
Academic End of year CBD
activities progress test
(YEPT-nt)
F1 1- Academic End of year 6 case-based Research Portfolio*** ITERS
half-days progress test discussions per
(Topic year
presentations
and journal
club)

27
 2- Answer MCQs
(quizzes)
**
F2 1- Academic 6 case-based Research Portfolio*** ITERS
half-days discussions per
(Topic year
presentations
and journal
club)
2- Answer MCQs
(quizzes)
**

** Answer 15 MCQs (quizzes). They will be discussed to ensure proper feedback and progress.
*** Portfolio needs to include data collection, reflection, and follow-up.
Refer to Appendix F.
Promotion Examination Blueprint

Topics Percentage

1 Microbiology 9%

2 Antibiotics /Antimicrobial stewardship 9%

3 Tropical diseases / Travel medicine / Emerging infectious diseases 8%

4 Fungal infections 5%

5 Exanthemtous diseases 5%

6 Immunodeficiency and immunocompromised patients 10 %

7 Sepsis and health care associated infections 9%

8 Congenital and Neonatal infections 5%

9 Immunization/ Chemoprophylaxis 6%

10 Infection control 8%

11 Ambulatory infections 8%

12 Specific infection (CNS, Res, GIT, GUT, Skin, Joint) 18 %

Total 100%

Note:
Blueprint distributions of the examination may differ by up to 3% in each category.
Refer to Appendix G.

28
3. Summative Assessment
SAUDI PEDIATRIC INFECTIOUS DISEASES FELLOWSHIP TRAINING PROGRAM
Final Examination 2021

The final Saudi pediatric infectious disease examination is composed of the following:

Written Examination:

1. One paper with 100 multiple choice questions (includes clinical scenarios with single best answer
out of four options.
2. Refer to appendix H.

No. Sections Percentage (%)

1 8%
Microbiology
2 10%
Antimicrobial agents / Antimicrobial stewardship
3 Tropical Diseases / Travel medicine / Emerging infectious 12%
diseases
4 5%
Fungal Infections
5 5%
Exanthematous Diseases
6 Immunodeficiency and Infection in immunocompromised 7%
Patients
7 8%
Sepsis and Health Care Associated Infections
8 6%
Congenital and Neonatal Infections
9 7%
Immunization / Chemoprophylaxis
10 7%
Infection Control
11 7%
Ambulatory Infections
12 Specific System Infections (CNS, Respiratory, GIT, GUT, 18%
Skin, Joint)
Total 100%

Clinical Examination

a. The pediatric infectious diseases final clinical examination shall consist of 4

graded stations each with 15 minute encounters.

b. The stations consist of 4 Structured Oral Exam (SOE) stations with 2 examiners each.

c. All stations shall be designed to assess integrated clinical encounters.

29
d. SOE stations are designed with preset questions and ideal answers.
e. Refer to appendix I.

DIMENSIONS OF CARE

Health
Promotion Chroni Psychosoci
Acute # Stations
& Illness c al Aspects
Prevention

Patient Care 2 1 3
DOMAINS FOR INTEGRATED
CLINICAL ENCOUNTER

Patient Safety &

1 1
Procedural Skills

Communication &
Interpersonal 0
Skills

Professional
0
Behaviors

Total Stations 1 2 1 0 4

30
31
CERTIFICATION OF TRAINING COMPLETION
Upon completion of training and passing of the final certification examination, the trainee will be
awarded the Saudi subspecialty certificate in pediatric infectious diseases.

32
 RESOURCES

Suggested Textbooks
1. Clinical Infectious Diseases
a) Textbook of Pediatric Infectious Diseases – Feigin & Cherry
b) Infectious Diseases of the Fetus and Newborn - Remington & Klein
c) Pediatric Infectious Diseases - Moffet
d) Principle and Practice of Pediatric Infectious Diseases – Sarah Long

2. Adult Oriented
a) A Practical Approach to Infectious Diseases - Reese & Bells
b) Principle & Practice of Infectious Diseases - Mandell
c) Tropical and Geographic Medicine - Warren & Adel Mahmoud
d) Hunter’s – Tropical Disease

3. Medical Microbiology
a) Medical Microbiology - Sherris
b) Medical Microbiology – Mims

4. Policies and Standard of Care

a) Red Book
b) MWWR – special issues

5. Review and Update

a) Seminar in Pediatric Infectious Diseases - 4 issues/year
b) Advances in Pediatric Infectious Diseases - once/year
c) Infectious Diseases Clinic of N.A.
d) Current Opinion in Infectious Diseases (All issues - August: Ped)
e) Current Opinion in Pediatrics (February)

6. Journals
a) The Pediatric Infectious Diseases Journal
b) Clinical infectious diseases
c) The Journal of Infectious Diseases
d) The Canadian Journal of Infectious Diseases
e) New England Journal of Medicine
f) Journal of Pediatrics
g) Pediatrics

7. Web Resources
The following websites may be consulted for recommended conferences and scientific events:
a) WSPID: World Society of Pediatric Infectious Diseases, www.wspid.com
b) ICAAC: Interscience Conference on antimicrobial agents and chemotherapy, www.icaac.org
c) IDSA: Infectious Diseases Society of America, www.idsociety.org
d) ESPID: European Pediatric Infectious Diseases Society, www.espid.org
e) ESCMID: European Society of Clinical Microbiology and Infectious Diseases: www.escmid.org
f) Local institutions’ CME calendars
g) Other Websites:
a. www.cdc.gov
b. Error! Hyperlink reference not valid.
c. www.pids.org

33
 APPENDICES

Appendix A: Universal Topics

Universal Topics in Infectious diseases
Module 1: Introduction
1. Safe drug prescribing
2. Hospital acquired infections
3. Sepsis, SIRS, and DIVC
4. Antibiotic stewardship

Safe drug prescribing: At the end of the learning unit, you should be able to:
a) Recognize the importance of safe drug prescribing in healthcare.
b) Describe the various adverse drug reactions with examples of commonly prescribed drugs that can
cause such reactions.
c) Apply principles of drug-drug interactions, drug-disease interactions, and drug-food interactions in
common situations.
d) Apply principles of prescribing drugs in special situations such as renal failure and liver failure.
e) Apply principles of prescribing drugs for elderly and pediatric age patients and during pregnancy
and lactation.
f) Promote evidence-based cost-effective prescribing.
g) Discuss ethical and legal frameworks governing safe drug prescribing in Saudi Arabia.

Hospital Acquired Infections (HAI): At the end of the learning unit, you should be able to:
a) Discuss the epidemiology of HAI with special reference to HAI in Saudi Arabia.
b) Recognize HAI as one of the major emerging threats in healthcare.
c) Identify the common sources and set-ups of HAI.
d) Describe the risk factors of common HAIs such as ventilator-associated pneumonia, MRSA,
CLABSI, and vancomycin-resistant Enterococcus (VRE).
e) Identify the role of healthcare workers in the prevention of HAI.
f) Determine appropriate pharmacological (e.g., selected antibiotic) and non-pharmacological (e.g.,
removal of indwelling catheter) measures in the treatment of HAI.
g) Propose a plan to prevent HAI in the workplace.

Sepsis, SIRS, and DIVC: At the end of the learning unit, you should be able to:
a) Explain the pathogenesis of sepsis, SIRS, and DIVC.
b) Identify patient-related and non-patient-related predisposing factors of sepsis, SIRS, and DIVC.
c) Recognize a patient at risk of developing sepsis, SIRS, and DIVC.
d) Describe the complications of sepsis, SIRS, and DIVC.
e) Apply the principles of management of patients with sepsis, SIRS, and DIVC.
f) Describe the prognosis of sepsis, SIRS, and DIVC.

Antibiotic Stewardship: At the end of the learning unit, you should be able to:
a) Recognize antibiotic resistance as one of the most pressing global public health threats.
b) Describe the mechanism of antibiotic resistance.
c) Determine the appropriate and inappropriate use of antibiotics.
d) Develop a plan for safe and proper antibiotic usage, including right indications, duration, types of
antibiotics, and discontinuation.
e) Be apprised of the local guidelines in the prevention of antibiotic resistance.

34
Module 2: Ethics and Healthcare
1. Occupational hazards of HCW
2. Patient advocacy
3. Ethical issues: treatment refusal, patient autonomy
4. Role of doctors in death and dying

Occupation Hazards of Healthcare Workers (HCW): At the end of the learning unit, you should be
able to:
a) Recognize common sources and risk factors of occupational hazards among HCW.
b) Describe common occupational hazards in the workplace.
c) Develop familiarity with legal and regulatory frameworks governing occupational hazards among
HCW.
d) Develop a proactive attitude to promote workplace safety.
e) Protect yourself and colleagues from potential occupational hazards in the workplace.

Patient Advocacy: At the end of the learning unit, you should be able to:
a) Define patient advocacy.
b) Recognize patient advocacy as a core value governing medical practice.
c) Describe the role of patient advocates in the care of patients.
d) Develop a positive attitude toward patient advocacy.
e) Be a patient advocate in conflicting situations.
f) Be familiar with local and national patient advocacy groups.

Ethical issues: treatment refusal, patient autonomy: At the end of the learning unit, you should be
able to:
a) Predict situations where a patient or family is likely to decline prescribed treatment.
b) Describe the concept of “rational adult” in the context of patient autonomy and treatment refusal.
c) Analyze key ethical, moral, and regulatory dilemmas in treatment refusal.
d) Recognize the importance of patient autonomy in the decision-making process.
e) Counsel patients and families declining medical treatment in light of the best interest of the patient.

Role of Doctors in Death and Dying: At the end of the learning unit, you should be able to:
a) Recognize the important role a doctor can play during the dying process.
b) Provide emotional as well as physical care to a dying patient and his/her family.
c) Provide appropriate pain management to a dying patient.
d) Identify suitable patients and refer the patient to palliative care services.

35
Appendix B: Infection Control Checklist
Met Partially Not
Met Met
Infection Control
The organization, infrastructure, and function of an IP&C Program.
The concept and methodology of surveillance; understand how
surveillance is performed for the CDC categories of nosocomial
infections like SSI, VAP, BSI, and UTI.
Epidemiology and laboratory investigation of nosocomial outbreaks.
The importance of Hand Hygiene (HH) in the prevention of infection.
Different HH agents, effects, side effects, and compliance.
Identify the common sources and set-ups of HAI.
Describe the risk factors of common HAIs, such as ventilator-
associated pneumonia, MRSA, CLABSI, and vancomycin-resistant
Enterococcus (VRE).
Identify the role of healthcare workers in the prevention of HAI.
Determine appropriate pharmacological (e.g., selected antibiotic) and
non-pharmacological (e.g., removal of indwelling catheter) measures in
the treatment of HAI.
Public Health
How to report and cooperate with the Ministry of Health.
Occupational Health
Post-exposure management of common ID exposures like Varicella, TB,
needle stick injuries.
Safety & Environment
Construction and renovation, including airborne pathogen risk
associated with construction, current standards for number of hand-
washing sinks, number of isolation rooms, ventilation parameters for
operating theaters, and ventilation requirement for construction of
oncology (BMT and non-BMT) units.
The principles of cleaning, disinfection, and sterilization of medical
devices and infectious waste management.
Lab safety.

36
Appendix C: Infection Control Objective
Trainees are provided the opportunity to observe the infection control unit’s organization and function.
They should actively participate in the Hospital Infection Control Program and attend the meetings of
the Hospital Infection Control Committee.
Infection Prevention and Control Rotation Objectives:
 The IP&C Program consists of 4 main sections: Infection Control, Public Health, Occupational
Health and Safety, and Environment.
 The functions within these 4 sections are more or less integrated, with the major goal being to
provide a safe environment for the patients, HCWs, visitors, and sitters.
 The Infection Control Section of the department deals with many aspects related to the prevention
and control of healthcare associated infections through education and surveillance.
 Fellows frequently rotate in IP&C to gain an understanding of the diverse areas of infection
prevention and control strategies.

SPECIFIC LEARNING OBJECTIVES:

Fellows rotating through the IP&C Training Program should acquire the knowledge of:
1. The organization, infrastructure, and function of an IP&C Program.
2. Evidence that IP&C Programs enhance patient safety and save money.
3. The role of the IP&C department within a medical institution.
4. How the IP&C department provides consultation services to the institution.
5. The role of the microbiology laboratory in infection control and surveillance.
6. The concept and methodology of surveillance. Fellows should understand how surveillance is
performed for the CDC categories of nosocomial infections such as SSI, VAP, BSI, and UTI.
7. The epidemiology and laboratory investigation of nosocomial outbreaks, including bio-typing,
phage typing, and plasmid analysis.
8. The importance of Hand Hygiene (HH) in the prevention of infection, the role of contact transmission
in infection, and the role of HH in preventing transmission. Different HH agents, effects, side effects,
and compliance.
9. The role of IP&C in the planning, construction, and renovation of healthcare facilities, including
airborne pathogen risk associated with construction, current standards for number of hand-washing
sinks, number of isolation rooms, ventilation parameters for operating theaters, and ventilation
requirement for construction of oncology (BMT and non-BMT) units.
10. How to report and cooperate with the Ministry of Health and other involved bodies.
11. The principles of cleaning, disinfection, and sterilization of medical devices and infectious waste
management.
12. How to advise occupational health and safety on infection control issues, including post-exposure
management of common ID exposures such as Varicella, TB, and needle-stick injuries.
13. Lab safety.

STRUCTURE OF ROTATION
Fellows will be required to:
1. Attend routine meetings in the department and participate in the decision-making discussion,
including the hospital’s Infection Prevention and Control Committee Meeting and Antibiotic
Committee Meeting.
2. Engage in the different surveillance activities from data collection to data presentation.
3. Join daily IP&C hospital rounds.
4. Conduct nosocomial outbreak investigations.
5. Become involved in the other activities of the IP&C department, such as Education –n-service,
Public Health Safety, and Environmental Services.

37
RESOURCES
1. Association for Professional in Infection Control and Epidemiology, APIC
Text of Infection and Epidemiology, 2005.
2. Mayhall, G., Hospital epidemiology and infection control (3rd edition) Philadelphia: Lippincott
Williams & Wilkins, 2004.
3. Heymann, D. Control of Communicable Diseases Manual (18th Edition), 2004. American Public
Health Association Publications.
4. Internet Websites:
1. Center for Disease Control and Prevention, Guidelines for Hand Hygiene in Healthcare
Settings: Recommendations of CDC and the Healthcare Infection Control Practices Advisory
Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
2. MMWR 2003; 52(RR10); 1-48.
3. Center for Disease Control and Prevention, Prevention and Control of Influenza:
Recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWWR
2003; 52(RRB): 1–36.

38
Appendix D: Microbiology Checklist
A. Blood Bench
Gram stain: differentiate gram +ve from gram –ve.
Blood cultures: ⃞ Fellow should participate in preparation of at least 5 blood gram stains +
inoculate in culture.
* Recognize different media:
Selective media:
⃞ L.J. media

⃞ Middle brook agar

⃞ Mannitol salt agar

⃞ Brucella agar

⃞ Thayer-Martin agar

⃞ Bordet-Gengou agar

⃞ Novy – Mac Neal – Nicolle (NNN) media

⃞ XLD agar
Differential media:
⃞ Blood agar plat

⃞ MacConkey agar

⃞ Sorbitol – MacConkey agar

Non-selective media:
⃞ Chocolate agar

⃞ Plat count agar

⃞ Nutrient agar
Ungrouped media:
⃞ Muller-Hinton agar

⃞ Sabouraud agar
Recognize different agars and tests for drug susceptibility.
⃞ Muller-Hinton agar

⃞ E. test

⃞ D. test for MRSA

* Recognize incubators and different automated machines and understand how they work
⃞ PCR (BD MAX)
⃞ PHOENIX M50

39
⃞ MALDTOF
⃞ SENSTITER (E-TEST ANTIFUNGAL)
⃞ URISED 3 PRO (URINE ANALYSIS)
⃞ MGIT 960 (TB C/S)
⃞ BACTEC FX
B. Stool Bench
* Recognize character of stool for different species:
⃞ Ova, Cyst, and parasite

⃞ Microscopy for Entamoeba

⃞ Microscopy for Giardia

⃞ Novobiocin disk (s. sprophyticus)

C. Urine Bench
• Recognize different methods of urine sample collection and proper transportation for
each test.
⃞ How to detect WBC in urine field.

⃞ How to detect bacterial colony in urine sample.

⃞ Microscopy for BK virus in urine.

⃞ Microscopy for adenovirus in urine.

⃞ Novobiocin disk ( s. sprophyticus )

• Recognize different tests for urine samples:

⃞ Nitrite

⃞ Leukocyte esterase

Serology:
• Recognize different inflammatory markers and their different methods of measurement:
⃞ CRP

⃞ ESR

⃞ Procalcitonin

• Recognize the principle of antigen and antibody reaction:

⃞ Brucella agglutination test

⃞ Brucella ELISA

⃞ Salmonella titer in stool (Typhoid serology)

⃞ Yersinia serology in stool

40
⃞ TORCH screening

⃞ Monospot test

⃞ Hetrophile antibodies for EBV antigens

⃞ CMV serology

⃞ Mycoplasma – Rapid cold agglutination test

⃞ Mycoplasma titer

⃞ Echinococcus granulosus serology

⃞ Toxoplasma serology – Congenital infection

– Non-congenital infection
⃞ Syphilis serology – Treponemal and Non-treponemal
Mycology:
• Recognize different agars and stains for fungus:
⃞ Sabouraud agar

⃞ Potato dextrose media

⃞ Dermatophyte test media

⃞ KOH stain

• Recognize different assays for fungal detection:

⃞ Galactomannan test:
- Procedure
- Cut-off value
- Kits
⃞ 1,3_B-D_glucan test:

- Procedure
- Cut-off value
- Kits
⃞ India ink
⃞ Silver stain for PCP
T.B.:
• Recognize different types of acid-fast stains (ZN, auramine, Kenyan…)
⃞ Positivity of AFB

⃞ QuantiFERON assay - Different type of tubes

- Procedure

41
 - Cut-off
⃞ Solid media for TB

⃞ Liquid media for TB

Parasitology:
⃞ Dark film

⃞ Differentiate between thick and thin film in malaria

⃞ Microscopic features of different plasmodium

⃞ Significance of different stages of malaria (Trophozoite, gametocyte)

⃞ How to calculate parasitemia

⃞ Microscopic features of Leishmania

⃞ Microscopic features of stool parasite

⃞ How to test for Schistosoma

⃞ Microscopic features of different types of Schistosoma

Virology:
⃞ Tzanck test

⃞ NPA for virology

⃞ Microscopic appearance of common virus (CMV, HSV, etc.)

Molecular lab:
- Understanding the principle of PCR
• Recognizing the importance of PCR in different pathogens:
⃞ PCR multiplex in respiratory secretion

⃞ TB PCR

⃞ TB PCR in detecting the sensitivity for anti-TB

⃞ HSV PCR in CSF

⃞ Enterovirus PCR in CSF

⃞ PCR in detection of viremia:

- Adenovirus
- HHV6
- CMV
- EBV
- HIV
- Hepatitis

42
⃞ PCR in urine for detection of:
- Adenovirus
- CMV
- BK virus
⃞ PCR in stool for detection of:
- Colostridium difficile
⃞ PCR in swab for detection of:
MRSA
Histopathology:
- Recognize the different pathogens and signs of diseases at the tissue level:
⃞ Acid-fast bacilli (AFB)

⃞ Granuloma in tissue

⃞ Different fungal characteristics at the tissue level:

- Yeast
- Hyphae (Recognize different types of hyphae)
⃞ Phagocyte in bone marrow

⃞ CMV inclusion body

⃞ Splendore-Hoeppli bodies in GIT tissue

⃞ Preparation of different kinds of tissue for reading.

For drug susceptibility test:
• Recognize different drug resistant patterns:
⃞ MRSA

⃞ MCIM

⃞ MDR

⃞ XDR

⃞ PDR

⃞ ESBL

⃞ MIC

⃞ MBC

⃞ TB MDR

⃞ TB XDR

Note:

43
* The aim of this checklist is to guide fellows during their laboratory rotation.
* This checklist does not cover all the lab items.
* This checklist will not be used for assessment purposes or achievement measures.
* Fellows should know that there will be differences among different labs in different centers in terms
of availability of some tests.
* Each item should be studied comprehensively.

44
Appendix E: Immunology Rotation
Objectives Knowledge Skills
Recognize clinical signs and Build-up and approach toward
symptoms that raise suspicion of child suspected of having
Ability to clinically
immunodeficiency. Know immune deficiency and request
suspect
common presentation and types specific test. Attend immunology
immunodeficiency in
of infection in various forms of clinic and in-patient service.
a child.
immunodeficiency (i.e., Recurrent
infection, chronic diarrhea, FTT).
Presentation of primary Ability to interpret laboratory tests
immunodeficiency, such as requested to confirm
Differentiate various antibodies deficiency, cellular immunodeficiency, such as
types of immune deficiency, neutrophil immunoglobulin levels, specific
immunodeficiency. defect (CGD, LAD, Chediak- antibody test, leukocyte marker,
Higashi), and rare form of blastogenesis, test of neutrophil
immune deficiency. dysfunctions, flow cytometry.
- When to refer to immunology - Take care of patients with
service. various types of primary
Develop management - Need for prophylactic immunodeficiency.
plan of child with antibiotics. - Follow-up and take care of
immunodeficiency. - Know which diseases are immunodeficient patients who
treated by stem cell undergo BMT.
transplants.
Management of Know peculiar infections in each Develop the clinical sense and
infectious type of primary ability to target probable
complications in immunodeficiency. pathogens in various clinical
immuno- settings.
compromised
patients.
Build theoretical knowledge about - Suspect and diagnose early,
various infections at different late post-BMT infections,
Diagnosis and times post-BMT (Early, late including viral, bacterial, and
management of infection). fungal infections.
infections post-BMT. - Recognize situations requiring
prophylactic antivirals,
antibacterials, and antifungals.
- Knowledge of available
Vaccination of childhood vaccines and their
immuno- efficiency in a specific host.
compromised host - Safe vaccine in immuno-
and post-BMT compromised host.
immunization. - Vaccine efficacy post-BMT and
scheduling.

45
Appendix F: Formative Assessment
Pediatric infectious diseases assessment tools:

Knowledge Skill Attitude

Academic activities End of year CBD
progress
test (YEPT-
nt)
F1 3- Academic half- YEPT-nt 6 case-based Research Portfolio*** ITERS
days (Topic discussions
presentations and per year
journal club)
4- Answer MCQs
(quizzes)
**
F2 3- Academic half- 6 case-based Research Portfolio*** ITERS
days discussions
(Topic presentations per year
and journal club)
4- 2- Answer MCQs
(quizzes)
**

** Answer 15 MCQs (quizzes). It will be discussed to ensure proper feedback and progress.
*** Portfolio needs to include data collection, reflection, and follow-up.

46
 Appendix G: Promotion Written Examination Blueprint

Topics Percentage

1 Microbiology 9%

2 Antibiotics /Antimicrobial stewardship 9%

3 Tropical diseases / Travel medicine / Emerging infectious diseases 8%

4 Fungal infections 5%

5 Exanthemtous diseases 5%

6 Immunodeficiency and immunocompromised patients 10 %

7 Sepsis and health care associated infections 9%

8 Congenital and Neonatal infections 5%

9 Immunization/ Chemoprophylaxis 6%

10 Infection control 8%

11 Ambulatory infections 8%

12 Specific infection (CNS, Res, GIT, GUT, Skin, Joint) 18 %

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Appendix H: Final Written Examination Blueprint Outlines

No. Sections Percentage (%)

1 8%
Microbiology
2 10%
Antimicrobial agents / Antimicrobial stewardship
3 Tropical Diseases / Travel medicine / Emerging infectious 12%
diseases
4 5%
Fungal Infections
5 5%
Exanthematous Diseases
6 Immunodeficiency and Infection in immunocompromised 7%
Patients
7 8%
Sepsis and Health Care Associated Infections
8 6%
Congenital and Neonatal Infections
9 7%
Immunization / Chemoprophylaxis
10 7%
Infection Control
11 7%
Ambulatory Infections
12 Specific System Infections (CNS, Respiratory, GIT, GUT, 18%
Skin, Joint)
Total 100%

48
Appendix I: Final Clinical Examination Blueprint*

DIMENSIONS OF CARE

Health
Promotion Chroni Psychosoci
Acute # Stations
& Illness c al Aspects
Prevention

Patient Care 2 1 3
DOMAINS FOR INTEGRATED
CLINICAL ENCOUNTER

Patient Safety &

1 1
Procedural Skills

Communication &
Interpersonal 0
Skills

Professional
0
Behaviors

Total Stations 1 2 1 0 4

DOMAINS FOR INTEGRATED CLINICAL ENCOUNTER

Definitions

Dimensions of Care Focus of care for the patient, family, community, and/or
population
Health Promotion & This is the process of enabling people to increase control over their
Illness Prevention health and its determinants, thereby improving their health. Illness
prevention covers measures to not only prevent the occurrence of
illness, such as risk factor reduction, but also to arrest its progress and
reduce its consequences once established. This includes, but is not
limited to, screening, periodic health exams, health maintenance,
patient education and advocacy, and community and population health.
Acute Brief episode of illness, within the time span defined by initial
presentation through to transition of care. This dimension includes, but
is not limited to, urgent, emergent, and life-threatening conditions, new
conditions, and exacerbation of underlying conditions.
Chronic Illness of long duration that includes, but is not limited to, illnesses with
slow progression.
Psychosocial Aspects Presentations rooted in the social and psychological determinants of
health that include, but are not limited to, life challenges, income,
culture, and the impact on the patient`s social and physical
environment.

49
 GLOSSARY

Glossary
Description correlating educational objectives with assessment
Blueprint contents. For example, test blueprint defines the proportion of test
questions allocated to each learning domain and/or content.
Capability to function within a defined professional role that implies
entrustment of a trainee by graduation of the program with the
Competency
required knowledge, skills, and attitude needed to practice
unsupervised.
Specialty Core Content
A specific knowledge, skill, or professional attitude that is specific
(skills, knowledge, and
and integral to the given specialty.
professional attitude)
An assessment that is used to inform the trainer and learner of
what has been taught and learned, respectively, for the purpose of
improving learning. Typically, the results of formative assessment
Formative assessment
are communicated through feedback to the learner. Formative
assessments are not intended primarily to make judgments or
decisions (although it can be a secondary benefit).
Exceeding the minimum level of competency to the proficient level
Mastery of performance indicating rich experience with possession of great
knowledge, skills, and attitude.
A collection of evidence of progression toward competency. It may
include both constructed (defined by mandatory continuous
Portfolio
assessment tools in the curriculum) and unconstructed
components (selected by the learner).
An assessment that describes the composite performance of the
development of a learner at a particular point in time. It is used to
Summative assessment
inform judgment and make decisions about the level of learning
and certification.
Knowledge, skills, or professional behavior that is not specific to
Universal Topic the given specialty, but is universal for the general practice of a
given healthcare profession.

50