History of the Division of General Paediatrics (Paediatric Medicine)
Prior to the formal development of the division, community-based paediatricians, with part-time faculty appointments made enormous contributions to the hospital and Department of Paediatrics through the provision of patient care and teaching on inpatient units and in ambulatory clinics. The Division of General Paediatrics was formally established in 1981, with Dr. Robert Hilliard as the first Division Head, and one of two full-time faculty. The division's initial mandate included overseeing several inpatient units, general paediatric clinics and walk-in clinics. During the 1980s, the general paediatric clinics developed a strong focus on secondary care, as well as collaboration with developmental and behavioural paediatricians and psychiatrists.
With the appointment of William Feldman as Division Head in 1991, clinical care and resource utilization became increasingly evidence-based. In 1992, Feldman established the Paediatric Outcomes Research Team (PORT), funded by The Hospital for Sick Children Foundation. PORT objectives included indentifying the most widely used health maneuvres for children, reviewing the literature to assess the evidence for their effectiveness and development of indepedent research proposals if the evidence was weak or inconsistent. Dr. Feldman established an Academic Fellowship, with the first fellow beginning in 1992. When the new hospital was opened in 1993, the division consolidated its inpatients onto the 7th floor inpatient units, staffed by a complement of full- and part-time faculty. The general paediatric clinics continued to develop a consultation model, providing paediatric consultation to community and SickKids paediatricians and the walk-in clinic was moved to the Emergency Department. Community-based paediatricians with part-time faculty appointments continued to make major commitments to teaching with a transition from hospital-based teaching to community-based teaching (offices and regional hospitals). Following Dr. Feldman's retirement in 1997, the division of General Paediatrics, Suspected Child Abuse and Neglect (SCAN0, Dermatology and Gynecology were consolidated into the one Division of Paediatric Medicine under the leadership of Patricia Parkin. Dr. Parkin successfully merged the previous divisions as sections under her leadership and created the new Section of Community Paediatrics to recognise the important contribution of the part-time members. In 2001, the Section of Gynaecology moved to the Division of Endocrinology in view of their collaborative clinical activities. In April 2004, Jeremy Friedman was appointed Division Head of Paediatric Medicine.
History of the SCAN Program
The SCAN program was established as a multidisciplinary program in 1973, with Dr. Robert Bates as the first Director. The early team consisted of two paediatricians, a psychiatrist, a social worker and an administrative assistant, all on a part-time basis. Increasingly, members of the multidisciplinary team became full-time, with Marcellina Mian appointed Director in 1984. Over the years, additional social workers, nurses and other professionals became part of the team.
The program served an increasing number of children from 115 in 1973 to about 800 in the 1990s. Prior to 1980, the majority of referrals dealt with physical abuse and neglect. In 1981, as the issue of child sexual abuse rose to the fore in North America, the Sexual Abuse Team was formed and later the two branches of the program became completely integrated. By the late 1980s, sexual abuse referrals had become more frequent than all other referrals. In 1992, a team of specially trained nurses was established to provide a coordinated approach to the care and treatment of all children presenting to the hospital's Emergency Department with
possible sexual assault.
Through education and advocacy, the program developed a growing regional, national and international reputation from the late 1980s onward and its members have contributed significantly to various programs intended to address the problem of child abuse and its prevention. In 2002, Dr. Mian became the Department of Paediatrics Undergraduate Medical Program Director and Dr. Michelle Shouldice became Section Head of SCAN.
The History of Paediatric Dermatology at SickKids
Paediatric dermatology started at SickKids in the 1960s with a group of physicians. Stuart Rogers, Bill Linton, Britain Sanders, Rosa Rappoport and Angel Trinchan provided one out-patient dermatology clinic at the hospital until 1969 when Lionel Boxall became the Chief of Paediatric Dermatology. Dr. Boxall started with one clinic a week in which approximately 25-40 patients were seen and eventually had two clinics per week. He built the Dermatology Division over a period of 26 years, retiring in 1995.
Dr. Boxall's first resident, Bernice Krafchik, took over as Division Chief of Paediatric Dermatology in 1995. She became the first full-time staff dedicated to academic and teaching endeavours in addition to clinical work. The number of clinics increased to five per week, with extras in association with rheumatology, vascular specialists and gynaecology.
Paediatric dermatology became involved in teaching at all levels at the University and internationally. Beginning in 1968, dermatology residents rotated through the hospital for periods ranging from three to six months and since 1990, at least one fellow has trained yearly in paediatric dermatology. Dr. Krafchik became an internationally respected speaker and an expert in the management of atopic dermatitis.
In 1997, paediatric dermatology became a Section under the Division of Paediatric Medicine. In 2003 Dr. Krafchik retired and Dr. Elena Pope, who had trained with Dr. Krafchik as a fellow, became Section Head. Currently, clinical work consists of 5,000 to 6,000 visits a year with at least two clinics running daily and an inpatient consultation service. The dermatology team includes two permanent staff members (Drs. Elena Pope and Miriam Weinstein) and three physicians with one to two clinics per week (Saul Greenberg, Nhung Ho and Christine Webster). Several multi-disciplinary clinics have been established, including a specialized morphea clinic, epidermolysis bullosa clinic and cutaneous T-cell lymphoma clinic. Clinical research began during Dr. Krafchik’s tenure and continues under the current leadership. Investigator-initiated grants and industry sponsored studies are ongoing.
Teaching continues to be an integral part of the program with dermatology residents being required to spend six months in paediatric dermatology during their training. In addition, paediatric residents rotate though the dermatology clinic and the program continues to attract fellows from both specialties, dermatology and paediatrics.