The annual APAC workshop began in 2008, as one step towards filling a large hole in postgraduate clinical training in New Zealand. Many paediatricians and advanced trainees lack confidence and experience in child protection. Many embark on a career as a consultant with little or no hands-on experience in the management of suspected physical abuse. In particular, most have never received any specific training around the court experience, have never appeared as an expert witness and feel extremely nervous about appearing in a criminal court.

Another key motive for development of the workshop was recurrent controversy about some of the scientific evidence behind the diagnosis of non-accidental injury (especially, abusive head trauma in infancy). Those who reach a diagnosis of child abuse must be well-trained, careful and objective in their approach, and embedded in a multi-disciplinary process which incorporates a wide range of expertise. Solo or idiosyncratic practice may easily become unsafe. The workshop is therefore designed to model a process and an approach which can be adapted to the clinical context of the attendee, not merely to impart isolated pieces of scientific knowledge.

No single doctor can incorporate the whole breadth and depth of clinical experience that may be required to evaluate the physical manifestations of child abuse. The workshop is based on practice at Starship Children’s Hospital, New Zealand’s tertiary children’s hospital, and explicitly draws on the expertise of a wide range of professional disciplines. Contributors come from the fields of child protection paediatrics, forensic pathology, paediatric neuroradiology, paediatric ophthalmology, paediatric orthopaedics, paediatric radiology and plastic surgery. In addition, we use an international expert in child protection paediatrics as an external auditor and contributor.

Since 2008, the annual workshop has expanded from two to four days, driven by course evaluations, which have always been extremely positive. The whole of the third day is now focused on giving evidence in court, including both evidence in chief and cross-examination. The teaching on this day is led by experienced criminal barristers.

The format is case-based and interactive, with bibliography and literature review. Subject areas include talking to families (role-play with actors), working with statutory authorities, abdominal injuries, bruises, burns, fractures, head injuries, documentation and writing reports and formal written statements. There is also a peer review session for attendees to present their own cases, and a dedicated session for our international contributor.

Historically, the target number for attendees has been no more than 40. The target audience is Consultants and Advanced Trainees in Paediatrics or related specialties (including Emergency Medicine and Surgical Specialties) where these cases form a part of clinical responsibilities.

The workshop is recognised by the Specialist Advisory Committee in General Paediatrics of the Royal Australasian College of Physicians as a child protection course suitable for advanced trainees in general paediatrics. Trainees from other professional disciplines (such as surgery and emergency medicine) have also attended the course and found it very helpful. We have begun enquiries about achieving recognition from other specialties for this course.

Dr Patrick Kelly

Paediatrician | Clinical Director, Te Puaruruhau | Starship Children's Hospital