GCF Chan

The practice of medicine has been changing drastically over the years due to the expansion of medical knowledge, advancement in technology and changes of disease spectrum. Whether the traditional "apprentice-style" training methods requiring a reform has been undergoing constant debate over the years. The Hong Kong College of Paediatricians launched a workplace-based assessment (WBA) in July 2025 as part of its transition from the old style to competency-based medical education. The idea of such reform was initiated several years ago and encountered resistance. Therefore, prior to the actual implementation, a WBA trainer workshop was conducted in May 2025. The article of So HY, et al tried to evaluate whether such train-the-trainer workshop could enhance the trainers' readiness and predict the possible problems and barriers that might occur during the system-wide implementation. It was found that the main effectiveness of such training was on the "perceived capability" of the trainers. In short, it helps to build the confidence of the trainers to the changes. While all the other domains tested did not show any significant differences, it was postulated that it is due to the high initial baseline scores (ceiling effect) of the participants. As the study pointed out, how to roll-out such new system to all trainers is a key issue. However, improving the teachers' teaching and assessment skills may be important, but the availability of adequate teaching materials is equally important. As the paediatric population is decreasing drastically, how to deal with the shrinkage of the clinical materials volume in many paediatric units is another major challenge. Prospectively design of mandatory rotation between the regional paediatric units and Hong Kong Children's Hospital is another important component in the training curriculum that should not be ignored. Afterall, the essence of work-based teaching and assessment is based on the clinical exposure to core clinical materials which should be adequately provided.

As demonstrated by the contents of this issue, both basic practice and complex problems will be encountered by paediatric trainees during their basic and higher paediatric training. They may also see these patients in their future practice. One of the common problems is hypoxic Ischaemic Encephalopathy (HIE). HIE is a devastation condition in neonatal unit for it has a major impact on the neurological development of the neonates. There are many interventional strategies and the article of Chandra S, et al illustrated a simple and economical way to improve the outcome which is in-NICU kangaroo mother care (KMC). KMC was done simply by placing a naked infant with mild to moderate HIE on the bare chest of mother for around 6 hours per day. In case the mother was sick or not available, any other guardian available to give skin-to-skin contact can do. By using prospective randomised control trial model, it showed that KMC group has a better survival rate (primary outcome), shorter NICU stay, and lower disease progression rate. A longer follow-up is needed to see whether such improvement can lead to better neurological outcome of the baby. Paediatric trainee should be familiar with such relatively simple but effective means in managing neonates.

In contrary to HIE, celiac disease is a relatively complex disease. It is a chronic enteropathy with highly variable multisystem manifestations after ingestion of gluten contenting food in genetically susceptible individuals. It is quite uncommon among East Asian but can be found in as high as 1/80 of the people in some European countries. The basic principle of treating this disease is a lifelong gluten-free diet. That means affected children have to take restrictive diet throughout their life. Therefore, the patients and their family are subjected to relatively high psychological stress. Taskin TG, et al explored the quality of life (QoL) status of Turkish children and their parents. As mentioned in this article, there are plenty of studies and articles describing the change in QoL of patients with Celiac disease, but they usually have no control arm for comparison. In this article, it was found that children diagnosed in the first two years, and their parents were more adversely affected in terms of their physical, social, and psychosocial health. As time goes by, they tend to adapt to the situation better. So intensive support should focus on the first 2 years of newly diagnosed celiac patients and their family. While it was rarely seen in Chinese previously, we started to see sporadic cases of this disease in recent years so trainees should be aware of such changing pattern.

While allogeneic haematopoietic stem cell transplantation (Allo-HSCT) is mainly performed in highly specialised training centre such as Hong Kong Children's Hospital, the long-term complications may be handled by other specialists or general paediatricians. Gut graft vs host disease (GvHD) is a common complication of Allo-HSCT. Usually, it is based on clinical features which match the typical disease manifestations of the gastrointestinal tract. The article of Jao Y, et al reviewed their experience and suggested the importance of performing endoscopic examination in delineating the actual disease process. In this series, gastrointestinal manifestations occurred in around 28.5% of patients who underwent Allo-HSCT. But only less than half of them were serious enough requiring endoscopic examination. Interestingly, in 14% of patient who underwent endoscopic examination, no significant abnormality could be identified suggesting the pathological site might be outside the examination territories. In addition, in histologically confirmed gut GvHD patients (n=24), quite high percentages of these patients have a mixed pathology such as GvHD with CMV (4/24), EBV (1/24) or even thrombotic microangiopathic anaemia (TMA) (14/24). Such findings highlight the importance of endoscopic examination if the patients' clinical condition showed relatively refractory course. Under the situation of mixed viral infection or TMA with GvHD, adding potent immunosuppressive therapy to these patients will not help or even aggravate the situation. Clinician should be aware of such mixed aetiology so management should target on more than one causative factor.

All those trainers involve in paediatric training should be aware of the diversity of paediatric illnesses. Common diseases such as respiratory tract infection, gastroenteritis, asthma, etc. can be adopted as "core knowledge". On the other hand, rare and complex diseases can illustrate disease mechanism better and are excellent clinical materials for teaching. All trainees should have the opportunity to expose to both aspects.