Paediatric Rheumatology (RPE_008)

1.Upon successful completion of the study course the resident acquires mandatory competence of a certified paediatrician. The necessary level of competence varies for various cases of paediatric rheumatic diseases and is provided in the table below.
The competence levels are the following:
1st level: acquired knowledge complies with general concept of the subject matter, allowing the practitioner to understand the situation by reading literature or when coming across in practice, by engaging in purposeful search for necessary additional information and referring the patient to a specialist, when necessary.
2nd level: acquired knowledge on the particular matter is sufficient for understanding its nature, to diagnose the problem and provide emergency aid, when necessary, refer to a specialist, as well as to carry out diagnostics, treatment and prevention under the supervision of a specialist.
3rd level: acquired knowledge allows the practitioner to solve the particular problem independently.

General part
1. Classification of paediatric rheumatic diseases 3
1.1. Classification criteria (anamnesis, physical, laboratory, radiological, histological examination methods)
1.2. Division of paediatric rheumatic diseases in main groups
1.3. Diagnostic criteria, classification of acute rheumatism and juvenile chronic arthritis
2. Epidemiological aspects of paediatric rheumatic diseases 3
3. Basic aspects of aetiology and pathogenesis of rheumatic diseases 2
3.1. Anatomy of bone-joint, muscular system, histological peculiarities
3.2. Synovial membrane, synovial fluid, cartilage tissues, blood system, connective tissues, collagen
3.3. Phases of inflammation, inflammation mediators, markers
3.4. Oncological aspects
3.5. Known etiological factors
4. Therapy principles for paediatric rheumatic diseases, selection principles, side effects, indications, application patterns
4.1. Non-steroid anti-inflammatory medications
4.2. Disease-modifying medications
4.3. Corticosteroids
4.4. Physical therapy
4.5. Physiotherapy
4.6. Movement therapy
5. Non-rheumatoid illnesses of the bone-joint and muscular systems (anamnesis, physical, laboratory and instrumental examination, peculiarities of care, differential diagnostics)
Special part
1. Juvenile chronic arthritis 2
2. Seronegative spondyloarthropathy 2
2.1. Juvenile ankylosing spondylitis
2.2. Psoriatic arthritis
2.3. Inflammatory intestinal diseases
2.4. Reiter syndrome
2.5. Reactive arthritis
3. Systemic lupus erythematosus 2
3.1. Systemic SLE
3.2. Neonatal lupus syndrome
3.3. Other hypersensitive diseases (Sjogren’s syndrome)
3.4. Antiphospholipid syndrome
3.5. Artherial hypertension
4. Juvenile dermatomyositis 2
5. Vasculitis 2
5.1. Primary (polyarteritis, leukocytoclastic, granulomatous, giant cell)
5.2. Secondary
6. Scleroderma and similar diseases 2
6.1. Systemic scleroderma
6.2. Localised scleroderma
6.3. Chemically induced scleroderma-like illness
6.4. Pseudoscleroderma
7. Diffuse mixed connective tissue disease (SHARP syndrome) 2
8. Immunodeficiency and rheumatic diseases 2
8.1. Primary immunodeficiency diseases
8.2. Immunologically associated diseases
8.3. Phagocytosis disorders
8.4. Rheumatic diseases related to complement deficit
8.5. T and B lymphocyte function disorders
9. Infectious arthritis 2
9.1. Septic arthritis
9.2. Viral arthritis
10. Acute rheumatic fever 2
11. Bone-joint system malignant diseases 2
11.1. Primary bone tumours
11.2. Bone metastasis
11.3. Synovial membrane tumours
11.4. Soft tissue tumours
11.5. Leukaemia
11.6. Rheumatic disease-like syndromes in cases of tumours
12. Skeletal dysplasia and bone-connective tissue metabolic diseases 2
12.1. Congenital diseases
12.2. Metabolic and nutrition disorder diseases
12.3. Accumulation diseases
Cardiovascular system
Acquired heart diseases
1. Bacterial endocarditis 2
2. Rheumatic heart diseases 2
2.1. Mitral valve insufficiency
2.2. Mitral valve stenosis
2.3. Aortic valve insufficiency
2.4. Aortic valve stenosis
2.5. Tricuspid valve insufficiency
2.6. Tricuspid valve stenosis
3. Myocardial disease
3.1. Non-infectious myocardial damage
3.2. Post infectious myocarditis
3.3. Myocarditis of other aetiology
4. Mitral insufficiency, diagnosis and therapy 2
5. Arterial hypertension, diagnosis, differential diagnosis, treatment 2
The competences given below are important but not comprehensive (the scope of competences can be extended should there be preconditions for that during the studies), they should be acquired in relation to a patient of the respective speciality, his/her parents, activities of the health care specialists, and type of health care organisation:
 To consult patients and their families
• to gather anamnesis;
• to carry out physical examination based upon the patient’s age;
• to assess growth and development;
• to perform dietary assessment;
• to evaluate psychological condition;
• to carry out clinical evaluation and make decisions;
• to provide explanations and consultations;
• to encourage and provide professional support.
 To evaluate clinical exposure, order examination, set diagnosis and agree on a treatment plan
• to recognise and evaluate severity of clinical exposure;
• to create differential diagnosis;
• to consider child protection issues;
• to order necessary examination and to interpret the results;
• to consult with multidisciplinary specialists;
• to agree on an appropriate health management plan with patients and their caretakers.
 To provide immediate healthcare to children in emergency situations, including first aid and resuscitation
• to recognise and evaluate acute paediatric emergency problems;
• to provide basic first aid;
• to provide paediatric emergency care;
• to provide cardiopulmonary resuscitation to neonatal and paediatric patients pursuant to the European guidelines currently in effect;
• to provide basic information in case of injury pursuant to the European guidelines currently in effect.
 To prescribe nutrition, medicinal products, liquid preparations and blood products
• to clearly and precisely prescribe nutrition, medicinal products, liquid preparations and blood products
• to coordinate nutrition, medicinal products, liquid preparations and blood products in clinical context
• to reconsider adequacy of treatment and to evaluate possible gains and risks;
• to treat pain and suffering.
 To carry out practical activities
A paediatrician is competent in performing various practical manipulations (see the list of manipulations) applied to infants, children and teenagers.
In relation to any of these manipulations the resident shall prove his/her ability:
• to provide respective information to the child and parents;
• receive informed consent, when necessary;
• to apply minimum possible invasive procedures;
• to reduce pain and suffering;
• to use appropriate hygiene and infection prevention activities;
• to make respective records on manipulations in the medical documentation.
 Ensure effective communication within the context of paediatrics
• to communicate with infants, children and teenagers;
• to communicate with caretakers and relatives;
• to communicate with other multidisciplinary specialists;
• to ensure continuity of healthcare;
• to stop or reduce bad news, to skilfully explain such news;
• to communicate with disabled children and teenagers;
• to communicate with people requiring interpreter’s assistance;
• to seek and receive informed consent, where necessary;
• to communicate in written form, including medical records, phone and other means of communication;
• to act adequately in cases of aggressive behaviour.
 To apply ethical and legal principles in paediatric care
• to apply ethical principles and analysis in clinical health care and research;
• to apply national and EU laws and regulations in clinical healthcare and research;
• to protect children’s rights pursuant to the United Nations Convention on the Rights of the Child and the laws of Latvia
• to maintain confidentiality;
• to evaluate patient’s ability to give consent;
• to obtain and record patient’s informed consent;
• to provide information regarding organ donation;
• to confirm a death;
• to write a request for autopsy.
 To assess psychological and social aspects of a patient’s illness
• to evaluate the impact of psychological factors on expressions of illness and the illness itself;
• to evaluate the impact of social factors on expressions of illness and the illness itself;
• to evaluate the impact of patient’s condition on education and school;
• to determine stress caused by illness to children, their families and caretakers;
• to detect alcohol and drugs abuse and dependence;
• to collaborate with respective colleagues in due time.
 To apply evidence-based medical knowledge, principles, skills
• to use evidence in practice;
•to identify and perform search of respective literature;
• to undergo a critical review of published medical literature.
 To efficiently use information and information technologies within context of paediatrics
• to complete clinical records in precise and complete manner and due time;
• to be able to access international scientific information on paediatrics;
• to save and obtain information.
 To be able to apply scientific principles, methods and knowledge in practice and studies related to children
• to apply scientific principles in paediatric practice;
• to analyse and distribute research results;
• to prove comprehension of research design and methodology, including statistical analysis.
 To facilitate individual and public health and to effectively operate within the healthcare system
• to comply with the national screening, monitoring and immunisation programs;
• to apply measures to prevent spread of an infection;
• undergo dietary assessment and provide useful advice and support on healthy nutrition, including ability to manage obesity and undernourishment cases;
• to study the risks of illnesses and harm to children and manage them accordingly;
• to promote safety of patients and prevention of accidents;
• to ensure compliance with the professional certification;
• to prove comprehension of the structure, organisation and operation of the healthcare system
 To perform one’s duties in professional manner
Professional qualities:
• honesty, decency and commitment to ethical practice;
• commitment to maintain good practice and quality;
• criticism and self-criticism, reflective practice;
• empathy;
• initiative;
• interpersonal communication skills.
Professional work:
• to acknowledge the limits of one’s possibilities and to ask for help;
• to work autonomously, when necessary;
• to solve problems;
• to pass decisions;
• to work in multidisciplinary groups;
• to contact experts, who do not represent disciplines of medicine;
• to demonstrate leadership skills;
• to be able to adjust to new situations and work in changing circumstances;
• to be able to organise and plan, as well as to understand time management;
• to make wilful career choice, including specialisation in sectors of paediatrics.
 To carry out functions of a paediatrician-expert
• to be able to analyse and synthesise;
• to be able to study (including life-long self-education) and to apply the knowledge in practice;
• to demonstrate teaching skills;
• to apply research skills.
 To carry out paediatrician’s functions in a global context
• to understand diversity and multiculturalism;
• to understand various cultures and traditions of migrants;
• to demonstrate proficiency in local language and culture;
• to be able to work in an international environment;
• to have responsive attitude towards environment and use of natural resources.