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Description of the Program

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  • 1. JOAN C. EDWARDS SCHOOL OF MEDICINE (JCESOM) MARSHALL UNIVERSITY (MU) TRAINING PROGRAM IN ENDOCRINOLOGY, DIABETES, METABOLISM, AND NUTRITION Description of the Program The training program consists of a two-year period of combined clinical endocrinology and endocrinology research activities. An optional third year is provided for those trainees who want to continue their research activities on a full-time basis. During the program, the trainee learns to diagnose and manage the full spectrum of endocrine and metabolic disorders and complications. He/she maintains his/her competence in general internal medicine, particularly those states leading to endocrine complications and those medical problems arising from primary endocrine diseases. At the completion of the program, the trainee will be qualified to enter the practice of general internal medicine with a subspecialty interest in endocrinology, the full-time practice of clinical endocrinology, or as an endocrinologist in academic medicine. The trainee also will be eligible for the subspecialty examination in endocrinology and metabolism offered by the American Board of Internal Medicine. Selection of Candidates Policy for Application, Recruitment, and Selection. Candidates must have completed successfully a 3-year general internal medicine residency in an ACGME accredited program and be eligible for the American Board of Internal Medicine examination for certification. The recruitment process begins two years prior to the beginning of the start time for the fellowship. Applicants apply for the position. In the past applications have been submitted directly to the program director. Applications were available at our web site. Starting July 1, 2005, candidates will apply through ERAS. As of July 1, candidates can open a My ERAS account. Applicants are directed to the ERAS site www.aamc.org/eras to open their ERAS accounts through the MyERAS website. As of November 15th, ERAS is open to candidates for official submission of application materials. Similarly, around that time, ERAS updated software (PDWS Software kit) will be sent to us to install in our offices. This gives us access to all the electronic applications. On December 1, all fellowship programs will have access to the application files. At that time, faculty in endocrinology will review applications, rank candidates and begin to offer interviews to candidates. This will continue through the end of February 2006. Letters of recommendations and Step 1-3 scores are reviewed. At least three letters of recommendation including one from their internal medicine program directors are required. After interviews, in early March, candidates are selected. . The Internal medicine program director reviews selections for the fellowship. Final decisions on selection of endocrine applicants remain with the endocrine program director. Offers are extended. The process of selecting fellows and their acceptance of offers should be completed by the end of March 15 months prior to the July 1 starting time. Out-of-Season Periods may occur in some years in selected cases for candidates applying off cycle. Program Staff Bruce Chertow, M.D. is Professor of Medicine and Anatomy at Joan C. Edwards School of Medicine (JCESOM) at Marshall University and Chief of Endocrinology and Metabolism at Marshall University School of Medicine and the Department of Veterans Affairs (DVA), Veterans JCESOM at Marshall University 1
  • 2. Affairs Medical Center (VAMC). Dr. Chertow is the medical director of the Marshall University Diabetes Center. He is board certified in general internal medicine, endocrinology and metabolism, and nuclear medicine. His research interests include cellular mechanisms of hormone secretion and in particular insulin secretion and abnormalities in secretion that may be important in the pathogenesis of diabetes mellitus. Dr. Chertow is the Program Director of the Endocrine Training Program. John W. Leidy, Jr., M.D., Ph.D. is Professor of Medicine and Physiology at JCESOM at Marshall University and Staff Physician and Research Coordinator at the Veterans Affairs Medical Center. He is board certified in general internal medicine and in endocrinology and metabolism. His research interests include growth hormone releasing hormone and hypothalamic pituitary secretion. Dr. Leidy is also Associate Director of the Endocrine Training Program. Henry Driscoll, M.D. is Professor of Medicine at JCESOM and Staff Physician at the VAMC. He is board certified in general internal medicine and in endocrinology and metabolism. His research interest is in the immunopathogenesis of diabetes. Jamie Bailes, Jr., M.D., is an Assistant Professor of Pediatrics, board certified in pediatrics. He has a special interest in type 1 diabetes and obesity. He is presently performing research using a high protein, low carbohydrate diet for children. Kimberly Matthews, M.S., is a research associate in our section of endocrinology. She is an integral part of fellowship training program for over 15 years. She has over 15 years of experience in medical research. Currently, Ms. Matthews is involved in laboratory projects concerning the role of vitamin A in islet development and hormone secretion. Mrs. Matthews manages the laboratory projects, orients and teaches fellows research methods, molecular biology including PCR and recombinant DNA techniques, radioimmunoassay, and handling of radionuclides. In addition, she is a member of the Research Safety/Biosafety Subcommittee and Animal Studies Subcommittee at the VA. Shailini Singh, M.D. is the director of the fetal diagnostic and therapy center in the Department of Obstetrics and Gynecology and has a particular interest in diabetes and pregnancy. Our fellows have opportunity to take a one-month elective with her. Dr. Singh also gives a lecture to our fellows on state of the art approaches and management of the high-risk diabetic pregnancy. William Burns, M.D is Chief of the Division of Reproductive Endocrinology and Infertility and Assisted Reproduction Center in the Department of Obstetrics and Gynecology. This center offers a full range of assisted reproduction techniques such as in vitro fertilization and gamete intra- fallopian transfer. Our fellows have opportunity to take a one-month elective with him. Dr. Burns also gives a lecture to our fellows on state of the art approaches to infertility. Fred Zangeneh, M.D. is a board certified pediatric endocrinologist on the West Virginia University (WVU) faculty at Charleston Area Medical Center (CAMC) in Charleston. Fellows have an opportunity to take a one-month elective with Dr. Zangeneh. Mary Beth Hummel, M.D. is Associate Professor of Pediatrics at WVU and is board certified in Pediatrics and Medical Genetics. She visits MUSOM monthly and gives a formal lecture every other month. Selected patients with inherited disease are presented to her for discussion of the molecular basis of disease, management and family counseling. Donald Primerano, Ph.D., is professor of medicine in the Department of Microbiology, Immunology and Molecular Genetics. He serves as the director of the Appalachian Cardiovascular Research Network (ACoRN) and director of the MU Genomics Core Facility. He advises faculty, fellows, and Kim Matthews on approaches and methods using microarray, RT- PCR, recombinant DNA techniques. JCESOM at Marshall University 2
  • 3. Richard Niles, PhD, is Chairman of Microbiology and Biochemistry and is collaborating with Dr. Chertow in research. Dr. Niles and Dr. Chertow have a common interest in the role of retinoids in gene transcription and cellular growth. Dr. Niles group participates in the basic science and research conference. William Rhoten, PhD, is Chairman of Anatomy, Cell and Neurobiology and is collaborating with Dr. Chertow in his research effort. Dr. Rhoten has special interest in islet structure and function and the role of intracellular calcium binding proteins. Dr. Rhoten and his group participate in the basic science and research conference Podiatrists. The VAMC has a Podiatry Service. Our section is consulted on diabetic patients with neuropathic feet and diabetic foot ulcers. This is an excellent resource for teaching our fellows about diabetic foot management. Additionally, patients are referred to Karen G Lo, DPM, in the Department of Orthopedics or Jeffrey Shook D.P.M., and Seth Stinehour D.P.M., practicing podiatrists. Pam Neal, RN, BSN, MSN-NA, C-FNP is a graduate of Marshall University. Ms. Neal received her Bachelor of Science in Nursing in 2000 and a Master of Science in Nursing, Nursing Administration in 2002. She received her Post-Graduate Certificate as a Family Nurse Practitioner in 2004. She works with members of the Endocrinology section of University Physicians & Surgeons. She also is a Clinical Research Coordinator for Drug Trials for the Department of Medicine, Joan C. Edwards School of Medicine. She is responsible for administrative activities and conducting patient visits in endocrinology trials. Anise Nash R.N., CDE, is a Certified Diabetes Educator. She is the coordinator of our ADA recognized Diabetes Self-Management Education Program. Fellows work closely with her in the education and care of their patients. Kristen Legleitner, R.N. is staff endocrine nurse of for the members of the Endocrinology Section. She acts as a liaison between patients and endocrinology physicians and arranges and/ or performs diagnostic tests on patients. Jennifer Stallings, R.D., CDE, is a Certified Diabetes Educator and Registered Dietitian in our ADA recognized program. Our fellows work closely with Mrs. Stallings in the diabetes education and dietary management of their patients. She shares in the care of patients and gives individual and group education sessions for our patients. RESOURCES AND FACILITIES The fellowship training program is one of the subspecialty training programs of the Department of Medicine at Joan C. Edwards School of Medicine at Marshall University. The program is an integrated program of two or three years' duration based at the three teaching hospitals affiliated with the School of Medicine, the Huntington Veterans Administration Medical Center (federal, 80 beds), Cabell Huntington Hospital (private, 300 beds), and St. Mary's Hospital (private, 400 beds). The VA Medical Center has veteran patients and the Cabell Huntington and St. Mary's Hospitals have mainly private patients. The medical clinics and diabetes center are located in the Marshall University Medical Center, an 185,000 square-foot, $32.2 million facility constructed in cooperation with and adjacent to Cabell Huntington Hospital. The Medical Center complex consists of the University Physicians Center, the Robert C. Byrd Center for Rural Health and a six-story atrium that connects the facilities to each other and to the Hospital. JCESOM at Marshall University 3
  • 4. The Veterans Administration Medical Center has 65 beds in medicine; the Cabell Huntington Hospital and St. Mary's Hospital each have approximately 100 beds in medicine. All three hospitals are geographically close to each other and to the Medical School. All hospitals have modern facilities and provide extensive medical services including nuclear medicine, radiology, pediatrics, obstetrics and gynecology, and laboratory that are particularly important to the diagnosis and management of endocrinology problems and diseases. Modern library facilities with internet access to the National Library of Medicine are available at the Huntington VA Medical Center and Marshall University School of Medicine. EDUCATIONAL EXPERIENCE Clinical. The first year of training will be devoted mainly to developing expertise in clinical endocrinology. The trainee will care for patients with a variety of endocrine problems. The sources of patients will be the Huntington VA Medical Center; St. Mary's Hospital, Cabell Huntington Hospital, and the University Physicians and Surgeons. Fellows see about 1-3 new and 5-7 return patients in an office setting. The differing nature of the patient makeup and endocrine problems and diseases at these different institutions provides a broad complement of endocrine problems and diseases for teaching purposes. The trainee will view patients from many perspectives including that of the primary physician or the endocrinology consultant. His/her involvement in the care will be direct or in a general supervisory role when directing PG-1 and PG-3 residents on the endocrinology service during an elective month. The attending endocrinologist will make consulting rounds several times a week and daily rounds on private patients. During rounds, the trainee will present the patient to the attending endocrinologist and review various aspects of the patient's problem or problems. During these rounds, bedside skills will be emphasized, and when appropriate, the physiology and biochemical basis of disease processes will be discussed. Dr. Chertow, the Chief of the Endocrinology Section, is in charge of endocrine imaging and DEXAs in Nuclear Medicine. He trains fellows in imaging of the thyroid, bone and adrenal with nuclides and the use of other diagnostic studies and laboratory tests using nuclides. He conducts two clinics at the VAMC, one for patients requiring radiotherapy for thyroid disease and the other for patients needing evaluation for osteoporosis. Radiology personnel will provide training in the radiographic evaluation and treatment of pituitary tumors; the indications for, and interpretation of, MRI and CT scans for endocrine tumors; angiography for the diagnosis of extension of pituitary tumors outside the sella turcica and for localization of pancreatic islet tumors; and catheterization studies for localization of ovarian, testicular, parathyroid, and adrenal tumors or hyperplasia. Close interaction with faculty in the Department of Pediatrics provides for access to children with endocrine problems and diabetes at the community hospital and allows for training in growth and development, childhood obesity, disorders of puberty, genetic diseases, and inborn errors of metabolism. Interaction with faculty in the Department of Obstetrics and Gynecology will provide patients for training in diagnostic approaches to disorders of menstruation and fertility problems and the diagnosis and treatment of thyroid and other endocrinology problems during pregnancy. The University Physicians and Surgeons, Inc, the school’s ambulatory care facility and the VA Medical Center will provide an outpatient setting for training and the management of general endocrine problems and ambulatory patients. After discharge from the hospital, patients from St. Mary's and Cabell Huntington Hospitals receive long-term ambulatory care at University Physicians and Surgeons. Also, veteran patients are seen at the VA endocrinology clinics. The clinics at both the University Physicians and Surgeons and VA Medical Center focus on the management of diabetes and its complications as an outpatient as well as other endocrine problems. The following varieties of clinical conferences are scheduled throughout the two-year training program. JCESOM at Marshall University 4
  • 5. 1. Endocrinology Grand Rounds (monthly) - Focuses on an endocrinology problem or disease. The trainee has the main responsibility with the assistance of the attending endocrinologist of presenting a case or lecture on a topic of his/her interest. In this role, the trainee not only learns from his/her preparation for the conferences but also develops experience as a teacher. 2. Endocrinology Journal Club (monthly) - This conference provides training in the critical review of articles on recent developments in endocrinology. 3. Endocrinology Curriculum Lectures (biweekly) - A staff endocrinologist will lecture on a timely topic 2 hours every other week. 4. During the two years of training, a research/basic science conference is held every two weeks where members of the Endocrinology Section and trainees present their research as it develops. These conferences provide training in scientific approaches and analyses, emphasizing creativity with critical thinking and review. Elective Experience. During the two-year experience year, a one-month clinical elective may be taken in specific areas such as reproductive endocrinology, pediatric endocrinology, or pregnancy and diabetes. Marshall University Diabetes Center is a cross-departmental diabetes center recognized by the American Diabetes Association. Patients from the tri-state region and southern West Virginia are referred to the center. Its staff uses the team approach, and offers one-on-one and group education sessions. Anise Nash R.N., CDE, is the coordinator of our ADA-recognized Diabetes Self-Management Education Program. Jennifer Stallings, R.D., CDE, provides dietary education and medical nutrition therapy. Fellows work closely with staff in the MU Diabetes Center. Research Experience. Research performed by Drs. Chertow, Leidy, and Driscoll involves basic mechanisms, and these investigators have an excellent knowledge in the basic sciences. All members of the endocrine section provide instruction in the basic sciences. At the beginning of his training, the trainee is assigned a preceptor for research activities with whom he can work closely in developing his research project. During the first year of clinical training, the fellow becomes familiar with other ongoing research activities in the Section of Endocrinology as well as in the Department of Medicine and other departments of the school. He/she will gain insight into the methods available for research studies. At the end of the first year, an area of investigation is chosen with the advice and consent of the assigned preceptor for research. A protocol is presented to the members of the Endocrinology Section and, after review, the trainee pursues the project during his second year of training. If the trainee elects, he/she may be offered and sometimes encouraged to take a third year of research to complete research activities. At the end of training, the trainee is expected to summarize, present, and consider his/ her work for publication. In addition to the endocrinology research conference, fellows can attend the basic science seminar given for graduate students by basic science faculty monthly. Evaluation of Core Competencies Core Competencies and Assessment The ACGME core competencies encompass the basic knowledge and skill necessary for the successful of practice of endocrinology. The core competencies are listed in the first column and required skill components of each competency listed in the second column of Table 1, which is attached, and on Internet link HTTP://WWW.ACGME.ORG/OUTCOME/ASSESS/TOOLBOX.ASP and evaluation methods are listed across the second row. Definitions of the tool box assessment JCESOM at Marshall University 5
  • 6. methods are attached and can be found at link HTTP://WWW.ACGME.ORG/OUTCOME/ASSESS/TOOLBOX.ASP. Evaluation forms covering the competencies and developed by the American Board of Internal Medicine are employed for this evaluation, and the attending and trainees should discuss the evaluation before the end of the review period and before the evaluation form is given to the program director and maintained in the trainee’s file. Fellows are required to keep their portfolios and log of procedures up to date. Fellows keep their own record of FNA procedures, indicating who supervised the procedure, and copies of the procedure logbook or equivalent documents are provided to the program director for the trainee’s file annually. Fellows are evaluated at 3-month intervals by all attendings. The fellow’s folio is reviewed at each evaluation by the program director. At 3, 9, 15 and 18 months interval evaluations using ABIM forms are reviewed with the fellows. At 6 months fellows get a written formative review and at 12 months get a summative review with a decision to promote the fellow or not to the PG 5 level (see promotion policy below). At 18 month another formative review is written and at 24 months a final summative review is written with a decision to graduate the fellow or not. The research mentor, using forms developed by the American Board of Internal Medicine, will evaluate the research performance of each trainee. Those evaluations will be discussed with the trainee and then forwarded to the program director for review and inclusion in the trainee’s file. Evaluation of the program by the graduates will be done periodically after completion of training. The evaluation will employ a survey instrument that asks the graduates’ perception of the program’s relevance to their current activities, suggestions for improvement and ideas for additions and/or changes to the curriculum. Policy for Promotion of Fellows. Interval Evaluations and Counseling of Fellows. All attending physicians that have contact with the residents formally evaluate residents every 3 months. Faculty contact with residents usually comes in periods of one to two month rotations as an attending consultant. Residents are also supervised by each attending 1 to 2 times a week in the clinic setting. Each faculty member evaluates the fellow and completes an evaluation form at 3-month intervals, and the written records are maintained in the program directors office. The evaluation by a faculty member at six months includes experience with the resident during about 2 months inpatient experience and approximately 12-48 clinic contact experiences. Evaluations include the new competencies of practice-based improvement and information systems-based practice. The fellows are expected to document competencies in a folio developed for each fellow. They are given a time schedule of evaluations, which describes what documents and competencies will be reviewed at each evaluation. After each evaluation the program director meets with the fellow and reviews the evaluations. The program director and fellow sign off on the evaluation. At 6-month intervals, the program director writes a formative narrative evaluation and makes recommendations for improvement, if any, to the fellow. If problems occur prior to that evaluation, the faculty member calls it to the attention of the training program director for formal documentation and discussion with the fellow. Annually, a summative formative evaluation is performed and documented formally. Monitoring Data Base of Knowledge. Fellows take an annual self-assessment that includes exam items comparable to test questions for the specialty boards in endocrinology. One is the Endocrine Self Assessment Program (ESAP), published by the Endocrine Society and Up-To- Date, and the other is the American Association of Clinical Endocrinologists Self-Assessment Program (ASAP), published by the American Association of Clinical Endocrinologists. They review the results of their tests for self-assessment of their progress. The faculty uses this information to assess the knowledge and progress of individual fellows. JCESOM at Marshall University 6
  • 7. Monitoring and documentation of each trainee's acquisition of skills in the performance of the procedures utilized in this subspecialty. Fellows are given a checklist of procedures. Every time they perform a procedure, the procedure must be signed by the attending indicating successful completion of the procedure. The list of procedures is submitted to the program director for the formal record. At the completion of their fellowship, fellows are competent in interpreting various laboratory tests and performance of different procedures. Resident performance of ultrasound-guided thyroid aspirations are observed and evaluated closely. The resident’s skill for thyroid aspirations is developed with repeated procedures. First, the fellow observes thyroid aspirations. When the attending endocrinologist is confident that the fellow is knowledgeable about a procedure, the fellow is allowed to perform the procedure under supervision. When the performance is judged satisfactory, the fellow can then perform a procedure in the absence of an attending physician. In general, the physician of record is present at all procedures. Promotion. Performance at the end of the PG4 year including evaluations in the six competencies, thyroid aspiration, and ultrasound skills are reviewed by the program director. If the fellow is judged to be competent by objective evaluations and achieved a level of competence and independence of action in the care of his patients, and there is a consensus among the faculty, the fellow is advanced to the second year of fellowship. The evaluation process is repeated during the second year of training. Upon successful completion of the second year, the fellow is graduated from his/her fellowship. Response by Resident. The program director reviews the evaluations with the fellow during a scheduled meeting every 3 months. The fellow has an opportunity to read and respond to their evaluations. The fellow signs off on the evaluations. The fellow can review his/her evaluations at any time between scheduled evaluations. If the fellow fails in a particular competency, the program director gives the fellow a warning about his/her deficiencies and develops a remedial plan with the fellow to correct the deficiency within a 3-month period. If the fellow continues to fail, the fellow is put on probation and given a 3-month period to correct the deficiency. The two-year program cannot be ended on probation or with a warning, and the training period must be extended 3-6 months if such a situation occurs. If the fellow fails again after being place on probation, the fellow is dismissed from the program. The fellow can appeal the decision with due process following GMEC policy. Rev. 102405 JCESOM at Marshall University 7

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