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  1. 1. University of Wisconsin Medical School -- Department of Pediatrics Pediatric Endocrinology & Diabetes Goals and Objectives for Fellows The fellowship in Pediatric Endocrinology and Diabetes is an ACGME fully accredited, three year subspecialty fellowship with the purpose of training fellows to be clinically competent in all aspects of the specialty and capable of achieving meaningful research accomplishments. By meeting the objectives of each of the three years of fellowship, the fellow will meet the requirements for application to the American Board of Pediatrics certifying exam in Pediatric Endocrinology. The pediatric endocrinology/diabetes fellowship at the University of Wisconsin provides training in the full spectrum of the specialty. Division faculty include two tenured full professors (Drs. David Allen and Michael MacDonald), two associate professors (Drs. Aaron Carrel and Ellen Connor), and one assistant professor (Dr. M. Tracy Bekx), each of whom is board certified in pediatric endocrinology. Dr. Todd Varness joined the division as an assistant professor, and is board-eligible. Drs. Allen, Carrel, Bekx, and Varness are graduates of this program. The Division also includes a research scientist, Dr. Ei Terasawa, and one diabetes nurse practitioner, and three diabetes and three endocrine clinical nurse specialists. Comprehensive clinical training in pediatric endocrinology is concentrated in outpatient (general endocrinology, diabetes, fitness, endocrine/oncology, and polycystic ovarian syndrome) clinics at the University of Wisconsin Children’s Hospital, which serve a population of over two million and provide over 3,000 endocrinology visits and 1,400 diabetes visits per year. Each clinic is staffed by at least two Division faculty. Weekly two-hour clinic preview sessions with attending faculty provide in-depth clinical instruction to fellows, residents, and students. During the first year of training, the fellow attends two half-days of Diabetes Clinic, three half-days of Endocrinology Clinic, and one half-day of either Polycystic Ovary Syndrome Clinic or Pediatric Fitness Clinic. The fellow also assumes appropriate clinical responsibility for inpatient consultations and admissions to the Children’s Hospital. During the second and third years of fellowship, outpatient clinic responsibilities are reduced to two total half-days per week, which allows for eight months of each year to be devoted to research activities. This research program includes a customized curriculum augmented by offerings of the University of Wisconsin Institute for Clinical and Translational Research (ICTR), including mandatory coursework in biostatistics and clinical research design. Throughout training, graduated teaching responsibilities for student, resident and faculty forums are provided. Year One A. Clinic Experiences 1. Inpatient: The fellow will consult on all patients admitted to the hospital on pediatric diabetes and endocrinology services and for all patients seen in
  2. 2. consultation. The attending physicians will contact the fellow upon notice of an admission or consult and will work with/supervise the fellow and the case. The fellow will complete a history and physical assessment, make a working diagnosis and consult with the attending physician in regard to treatment and/or therapies, discharge planning and outpatient follow-up. The fellow will document in the patient’s medical record in keeping with established practices. 2. Outpatient: The fellow will attend 5-6 half-days of clinic per week from the following pediatric diabetes and endocrinology outpatient clinics: Diabetes Clinic meets Monday all day, Tuesday morning and Thursday morning. Endocrinology Clinic meets Monday morning, Tuesday afternoons, Wednesday mornings, Thursday afternoons, and all day Friday. Pediatric Endocrine-Oncology clinic is incorporated into alternate Monday morning Endocrine Clinic with Dr. Allen, Polycystic Ovary Syndrome Clinic meets twice-monthly, and Pediatric Fitness Clinic meets on Friday mornings. a. Each fellow will be responsible for caring for approximately one-third of all patients seen in each clinic. This will include history taking and physical exam/assessment, counseling, formulating and communicating recommendations and also conducting follow-up with patients and referring physicians regarding laboratory results and other issues following the initial visit and all subsequent outpatient visits. b. The fellow will discuss the patients with an attending physician. The attending physician will see the patients and will review and counter-sign the fellow’s written notes in the patient’s medical record. 3. The fellow can attend selected diabetes and endocrinology outreach clinics held during year one. Currently diabetes outreach clinic is held quarterly at St. Elizabeth Hospital in Appleton. 4. The first year fellow will spend 4 weeks on the Genetics/Cytogenetics rotation learning principles of genetic diagnosis and counseling, FISH analysis and karyotyping, and tissue culture. 5. Call schedule: The fellow will be on call from 8:00 a.m. Monday to 12:00 p.m. Friday for the first three weeks of each clinical month during year one. The fellow will take first call from home on weekdays with the exception of one 24-hour weekday period during each of these three weeks (during which the fellow is completely call free). The fellow also takes home call 2 weekends each month. B. Teaching 1. Medical students and residents: During year one, the fellow will substantially contribute to the teaching of medical students (both third and fourth year students) and residents who rotate through the pediatric endocrinology service,
  3. 3. as well as students and residents on ward rotations coming in contact with endocrine patients. 2. The fellow will serve as a small group leader for the UW Medical School second year Endocrine Pathophysiology course. 3. Educational presentations: a) The fellow will present at the Pediatric Endocrine Conference each month in year one. b) The fellow will participate in weekly didactic talks and chart review sessions for the pediatric residents and medical students. c) The fellow will prepare for case-based discussions at weekly Fellowship Director’s Conference. C. Coursework and Educational Conferences 1. The fellow will complete the UW ICTR Short Course in Grant Preparation during the first year. 2. The fellow will attend the GME Lecture Series for UW housestaff and the teaching series presented to fellows in adult endocrinology when relevant to their training. 3. The fellow will attend the following conferences as relevant topics are presented: a) Endocrine Grand Rounds b) Pediatric Ethics Rounds c) Pharmacology Seminar d) Physiological Chemistry Seminar e) Pediatric Grand Rounds f) Nutrition Research Seminar g) Pediatric Diabetes Conference h) Nuclear Medicine/Endocrine Conference i) Adult Endocrinology Case conference j) Pediatric Research Seminar (department-wide) k) Pediatric Endocrinology Research meeting (monthly) 4. The fellow will attend the sleep & fatigue conference “Sleep, Alertness and Fatigue in Education”, if available, or view the SAFER sleep deprivation video which is available through the residency office. D. Research Experience – two months of year one are devoted to this.
  4. 4. 1. The fellow will be introduced to various research opportunities within the Division of Pediatric Endocrinology and Diabetes and with collaborating UW researchers. 2. The fellow will discuss a preliminary research plan with their Scholarship Oversight Committee and with the Program Director. 3. The fellow will select a research project and will begin preliminary work to learn background information, write the research plan and grant, and prepare human subjects materials if needed. E. Fellow, Staff and Program Evaluation 1. Fellow and staff: The fellow will complete written evaluations of the staff biannually. Results will be discussed with the program director. At the same meeting, the staff’s biannual evaluation of the fellow and his/her progress within the program will be reviewed and discussed. 2. The fellow will complete written evaluations of the fellowship program biannually at the same time as the staff. Results of the evaluations will be discussed at a section meeting, with plans for improvement (if needed) to be developed and documented in meeting minutes. Years Two and Three A. Clinical Experiences: 1. Inpatient: During years two and three, the fellow will consult on the inpatient pediatric diabetes and endocrinology services for three months. The fellow will consult on patients admitted to the hospital on pediatric diabetes and endocrinology services for patients seen in consultation. 2. Outpatient: The fellow will attend two Diabetes and/or Endocrinology clinic per week during years two and three. During year three, the fellow will spend four weeks on the (adult) internal medicine endocrinology services. During these rotations, the fellow will be supervised by the internal medicine endocrinologists. In addition, in year three, the fellow will spend four weeks on a combined Endocrine Imaging/Lipids Disorder rotation, during which the fellow will be supervised by faculty in Nuclear Medicine and Preventative Cardiology. 3. During year 2, the fellow will complete a 4 week rotation in Endocrine Laboratory Medicine to observe, learn and perform (to the extent possible) standard endocrinology tests performed in the UW Health Clinical laboratories and in other sites on the UW campus. This may include diagnostic steroid studies, hormone receptor assays, molecular diagnostic techniques, HPLC, and other immunoradiometric tests under the supervision of Dr. Teresa Darcy.
  5. 5. 4. Call Schedule: The fellow will be on call from 8:00 a.m. Monday to 12:00 p.m. Friday for three months of year two and three. During these on-service months, the fellow will take first call from home on weekdays with the exception of one 24 hour weekday period during which the fellow is completely call free, and will take home call 1-2 weekends per month. B. Teaching and coursework 1. The fellow will assume progressive responsibility for teaching medical students and residents during their on-service months during years two and three. This will include, but is not limited to, leading a weekly two-hour chart review and conducting weekly case-based discussions of topics included in the core pediatric endocrinology curriculum. 3. The fellow will serve as a small group leader for the UW Medical School second year Endocrine Pathophysiology course. 4. The 2nd and 3rd year fellow will prepare, research, and present case-based problems to Division faculty on a monthly basis. 5. The 3rd year fellow will present (at least) once per year at Adult Endocrinology Grand rounds. 6. The 2nd year fellow will complete the ICTR-sponsored workshop in Manuscript writing. 7. The fellow will complete graduate level coursework selected from the following areas: (* = required) a. Biochemistry b) Nutritional science c) Biostatistics* d) Research study design (ICTR-sponsored course)* e) Molecular medicine/biology f) Genetics g) Medical Ethics* C. Fellow, Staff and Program Evaluation 1. Fellow and staff: The fellow will complete written evaluations of the staff biannually. Results will be discussed with the program director. At the same meeting, the staff’s biannual evaluation of the fellow and his/her progress within the program will be reviewed and discussed. 2. The fellow will complete written evaluations of the fellowship program biannually at the same time as the staff. Results of the evaluations will be discussed amongst faculty and fellows at a section meeting specifically dedicated to Fellowship Program Review, with plans for improvement (if needed) to be developed and documented in meeting minutes. D. Preparation for and Taking of Subspecialty-in-Training Exam
  6. 6. Fellows will receive support to enroll in and attend the Lawson-Wilkins Pediatric Endocrine Society Board Review Course in Pediatric Endocrinology, which is offered every two years. During each year, the fellow will take the American Board of Pediatrics SITE exam to determine his/her progress toward the goal of taking the Pediatric Endocrinology certifying examination the following year. The fellow will receive support for the costs of this examination from the Division. Results will be reviewed with the program director and staff. E. Laboratory/Research Experience 1. The fellow will have selected a research project and will have begun preliminary work to initiate the research project in YEAR ONE. This will include selection of and acceptance of a research mentor, plans for funding and laboratory space, and preliminary lab work. Progress will be monitored by the Departmental Fellowship Scholarship Oversight Committee. 2. During years two and three, the fellow will design, conduct, evaluate and prepare for publication a clinical or laboratory research project in the subspecialties of pediatric diabetes and/or pediatric endocrinology. 3. The fellow will conduct research seminars. 4. At the end of year three, the fellow will prepare for the program director a written summary report of research activities, including submitted and/or accepted publications. 5. The fellow’s research accomplishments will include at least one of the following: a. A first-authored research paper accepted for publication in a peer-reviewed journal. b. In lieu of an accepted paper, the fellow may prepare a research progress report. This report must be no longer than five pages, and must include a statement of hypothesis, delineation of methodology, results and analysis, and the significance of the research. Plans to submit a research paper within two years must be documented and approved by the program director. If a research project produced negative results or the outcome of the research is not publishable, it is the intent of the research, not necessarily the outcome, that is important. If a fellow has shown the necessary involvement in designing and implementing a research project to the satisfaction of his mentor and/or the program director, and this is clearly described in a progress report, the goal has been met. c. A first-authored research paper, deemed acceptable by the program director, which has been submitted to a peer-reviewed journal but not yet accepted for
  7. 7. publication. A letter from the journal confirming the submission of the manuscript must be secured. Current research interests/opportunities of Pediatric Endocrinology faculty: The Division currently has active, externally funded research projects in both clinical and basic science areas. Of note, the Division was awarded an NIH T32 Training grant beginning in 2008 with first renewal scheduled for 2013, with a broad focus of expertise in childhood obesity and diabetes prevention. Beta cell biochemistry (laboratory of Michael J. MacDonald): A fellow would have the opportunity for an independent, but well-supervised, project that combines metabolism with molecular biology to understand the mechanism of insulin secretion in the pancreatic beta cell. Fellows would have the opportunity to interact with two M.D./Ph.D.s, one or two additional Ph.D.s, as well as students, and to have technical support from and/or interact with up to three research specialists. This research is supported by a five-year NIH grant. The grant cannot support a clinical fellow’s salary; however, the grant could support a research project relevant to the specific aims of the grant application. Genetics of type 1 diabetes (mentor Dr. MacDonald): Opportunities exist for undertaking a research project with direct clinical relevance. Collection of samples from type 1 diabetics and their parents is ongoing. DNA samples from over 500 children with type 1diabetes are available for analysis. The fellow would begin to identify alleles of candidate genes in selected chromosomal regions containing type 1 diabetes susceptibility loci. While there is no money available to support a clinical fellow’s salary for this project, support for the research project is available from the UW Children’s Diabetes Center. Childhood obesity: community- and school-based strategies to promote fitness and improve body composition and insulin sensitivity (mentors Drs. Carrel and Allen, with Dr. Bernhardt from Sports Medicine): The Division is currently conducting collaborative research with Stoughton and Madison Metropolitan School Districts studying the effects of implementation of fitness-based physical education program. This research is currently grant supported, and applications are submitted to NIH and to the Wisconsin Blue Cross/ Blue Shield grant program. Extensive opportunities exist in this area, now the highest funding priority for granting agencies with regard to childhood health. Effects of in utero environment on offspring islet cell function, body composition, and diabetes risk. (mentor Dr. David Abbott, Department of Ob- Gynecology, and collaborating T32 faculty member) Dr. Abbott has developed a primate model of maternal hyperandrogenemia and insulin resistance which facilitates the study of in utero programming of insulin synthesis, secretion, pancreatic morphology, and body composition effects of offspring exposed to this
  8. 8. environment. Current fellow Dr. Lindsey Nicol has conducted her research project in this setting. Growth hormone treatment of children with Prader-Willi syndrome (mentors Drs. Carrel and Allen): For the past 15 years, the Division has been an international leader in this area. Research is currently supported by a four-year grant from Pfizer, Inc, a previous five-year NIH grant, and an additional NIH grant proposal has been submitted. Fellow would have the opportunity to take a leading role in analysis of a cohort of infants/toddlers currently receiving treatment, with the key question being whether early institution of GH therapy prevents the deterioration in body composition and improves strength, tone, and attainment of developmental milestones. Other divisional basic and laboratory research activity research activities include: 1. Early detection and preventative treatment of evolving IDDM (Drs. Michael MacDonald and Ellen Connor). 2. Innovations in newborn screening for congenital hypothyroidism and congenital adrenal hyperplasia (Drs. David Allen and Todd Varness). 3. Clinical characteristics and course of adolescents with Polycystic Ovary Syndrome (Drs. Tracy Bekx and Ellen Connor). 4. The physiology of puberty in primates (Dr. Ei Terasawa). This academic environment enabled the previous pediatric endocrine fellows to accomplish the following: Dr. David Allen completed three research projects and published 13 manuscripts describing research and clinical observations during his three-year fellowship. Dr. Aaron Carrel published four original manuscripts, three reviews/chapters, and was recognized for the Outstanding Clinical Academic Physician (CAP) abstract presentation of the NIH CAP annual meeting. Dr. Tracy Bekx published one original manuscript. Dr. Todd Varness has several abstract presentations, one of which was awarded Presidential Symposium citation at the 2008 PAS meeting, has published one paper, with another under review. University of Wisconsin-Madison Pediatric Endocrine Fellowship Competency-based Goals and Objectives (Cross-reference with rotation-specific competency-based Goals and Objectives) Goals and Objectives for the Program as a whole The goals of the University of Wisconsin-Madison Pediatric Endocrine Fellowship are that graduates will attain the professional, attitudinal, cognitive, and technical skills necessary to provide their patients and their families with kind and compassionate care in the specialty of Pediatric Endocrinology. Pediatric endocrine fellows have many opportunities to learn and practice patient communication and shared decision making and to apply current evidence-based knowledge to achieve the best likelihood of the
  9. 9. patient’s desired outcome. Pediatric endocrine fellows are given guidance and advice to develop their careers, achieve scholarship, and complete the prerequisites needed for the next steps of their careers. Our fellows will learn how to problem solve in all areas relevant to the specialty, and will display self-directed life-long learning. Fellows are taught to assess patient outcomes in order to improve future decision making and guide practice management. They will refine their ability to organize their workdays, as well as reflect upon and plan for professional-personal balance, stress reduction, and personal health. The competencies listed below are achieved through a carefully selected plan of clinical and research experiences, a didactic curriculum, coursework in study design and biostatistics, self-tailored electives. Our pediatric endocrine fellows, faculty, and program are continuously evaluated to ensure success in achieving these competencies, goals and objectives. Competencies 1. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Through exposure to well-supervised comprehensive clinical training experiences in Pediatric Endocrinology, didactic curriculum, and independent study, the knowledge and skills needed to select and deliver appropriate and effective subspecialty care in Endocrinology and Diabetes will be obtained. In achieving this competency, pediatric endocrine fellows will demonstrate that their actions serve the interests of their patients above their own self-interest and exhibit during their clinical care rotations and in discussion forums the following characteristics: altruism, accountability, reliability, courtesy, sensitivity, integrity and respect for others. Further, pediatric endocrine fellows are required to experience and to aid in the delivery of services and programs that advocate for the well-being and promotion of health of children. 2. Medical knowledge about establishing and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Pediatric endocrine fellows will acquire and demonstrate a sound level of understanding of the clinical, basic and social sciences that underlie the practice of Pediatric Endocrinology, and be able to demonstrate that they can apply their knowledge to patient care, patient education, family education, and the education of other members of the health care team. Areas of knowledge will include understanding the pathogenesis, pathophysiology, epidemiology, historical issues, relevant physical findings, test utilization (including relative sensitivity and specificity and likelihood ratios), means of confirming a diagnosis, treatment, monitoring and prevention of the most common inpatient and outpatient clinical disorders cared for by Pediatric Endocrinologists. Pediatric endocrine fellows will be able to apply evidence-based medicine to investigate, evaluate and improve the patient care that they offer. They will understand how to be aware of the limits of their personal knowledge and experience, set clear learning goals to pursue, explore new opportunities for intellectual and professional growth and then apply new knowledge to their practice that they ascertain as being quality information.
  10. 10. In addition, pediatric endocrine fellows will understand how various aspects of disease are affected by gender, age, ethnicity, culture and disability. In addition to understanding and being able to manage the disorders relevant to Pediatric Endocrinology, pediatric endocrine fellows will incorporate into their practice the following areas that cross all specialties: ethics, psychology, medical-legal issues, medical economics, managed care, public health, familial and societal violence, AODA issues, informatics, record keeping, quality assurance and risk management, and relevant areas of other pediatric and non-pediatric specialties (e.g. hematology/oncology, genetics, neurology, dermatology, nephrology, ophthalmology, orthopedics and sports medicine, rehabilitation medicine, psychiatry). Prior to the completion of training, all pediatric endocrine fellows will demonstrate scholarly activity in accordance with the American Board of Pediatrics requirement. All pediatric endocrine fellows will develop and conduct a hypothesis-based research project, requiring close collaboration with a research mentor, and leading to presentation/publication of results. This scholarly activity will be monitored by the fellow’s individual Department Scholarship Oversight Committee. Pediatric endocrine fellows will demonstrate their ability to frame a question based on a problem needing to be solved in their clinical practice or research programs, perform a comprehensive literature search using appropriate skills and sources, resolve which sources of information are accurate and applicable by using critical reading of the literature skills and apply the results of their work to the original inquiry. Fellows will be evaluated on their ability to: 1) apply evidence-based medicine to their scholarly presentations and clinical practice; 2) present educational topic and research-focused lectures in a grand rounds-style public forum. 3. Practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care. In the conduct of their inpatient and outpatient practice settings, pediatric endocrine fellows will need to demonstrate in areas for which they have limited prior experience the ability to recognize a problem, characterize it, formulate a question that needs to be answered in order to address the issue, identify sources of information, find and critically appraise relevant literature for accuracy and completeness and develop a plan of action in an effort to solve the problem. They will integrate and interpret factual information, extract knowledge that is relevant to their patient and apply it to their patient after recognizing factors that may influence the plan such as cost, opposition, alternate strategies and adverse effects. In addition, they will subsequently assess the results of their action. Pediatric endocrine fellows will exhibit tolerance and consideration of opinions from others, understand the socioeconomic and cultural context of the problem, consider the problem as an opportunity for change and advancement of knowledge and seek help when the problem is outside the range of knowledge that they possess. This will require that the pediatric endocrine fellow be observant, empathetic, and a good listener, be able to recognize contradiction, discrepancy, and separate normal from abnormal
  11. 11. findings, organize information, identify issues that have the greatest impact, and estimate the implications of the problem, its severity and extent. Affecting the plan is a key skill for the pediatric endocrine fellow to demonstrate as well as assessing the outcome of their strategy. Pediatric endocrine fellows will learn how to analyze and evaluate their practice experience and implement strategies to improve their practice. They will learn to self- evaluate cognitive, technical, attitudinal and procedural aspects of care. They will need to be able to recognize and admit error and develop a system or process to reduce error and near misses. They will need to know how to use information technology to access and manage information and to reduce error and support patient care decisions. They will need to find information technology that allows their education and their patients’ education to continuously improve. 4. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals. Graduates of the Pediatric Endocrinology Fellowship will demonstrate effective written, verbal and non-verbal communication when participating in patient care, consulting and collaborating with colleagues and co-workers, and teaching and presenting in the academic center, in the community and most importantly during information exchange and collaboration with patients, parents, and their loved ones. Pediatric endocrine fellows will demonstrate effective listening skills and be able to demonstrate to their patients and parents that they understand their needs. Pediatric endocrine fellows will display that they can create a therapeutic relationship with patients and parents by using effective communication skills, interpretable language, active and responsive listening, patient education and counseling and assisting other professionals to do the best job possible for infants, children, and adolescents of common concern. Pediatric endocrine fellows will be able to define their own leadership skills and type of leadership qualities that they possess as well as the strengths and weaknesses of their own leadership style. Pediatric endocrine fellows will understand how to alter their communication techniques to be more effective leaders. This will include the ability of a pediatric endocrine fellow to understand how others perceive them, to be able to modulate what they do so that others perceive them in a more positive light, and to use communication to help themselves and others find motivation, be optimistic and create a positive environment with particular emphasis on instilling hope in their patients and their loved ones. 5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Pediatric endocrine fellows will demonstrate their pursuit of continuous professional development and will be responsive to the needs of patients and society. Pediatric endocrine fellows will demonstrate as one of their core values that they truly care for their patients by doing their best in serving their patients needs and most importantly by
  12. 12. consistently demonstrating true compassion; that is, an emphatic attitude that leads to an action to reduce the suffering of others. Important aspects of this competency are effective interactions with other members of the healthcare team, an absence of hubris and willingness to obtain help from other professionals, a cooperative style of working with teams, and a willingness to recognize and take appropriate action when witnessing unethical behavior. Pediatric endocrine fellows will recognize the ethical dimensions of medical practice and health care policy. All pediatric endocrine fellows will demonstrate principles of patient rights to autonomy, beneficence, and justice. Pediatric endocrine fellows will incorporate these principles into their patient care, clinical decision-making and discussion groups by: • Ensuring patient’s or, when appropriate, parents’ rights to self-determination and decision-making. This will include the proper use of advanced directives, durable power of attorney for health care, surrogate decision making, informed consent, implied consent, disclosure, confidentiality and futility. • Acting in good faith to preserve life, restore health, reduce suffering and restore or maintain function without abandonment or conflict of interest. • Removing, preventing and doing no harm by upholding the standards of professionalism, confidentiality, compassion and effective communication and using effective palliation and emotional support. • Allocating medical resources fairly and according to medical need and optimal benefit to the patient. • Applying the medical-legal issues surrounding withdrawing or withholding life support. Pediatric endocrine fellows will be able to identify alternatives for difficult ethical choices by systematically analyzing situations and considerations that are conflicting and ideas that support different alternatives. Pediatric endocrine fellows will be able to formulate, defend, and carry out a course of action that takes into account ethical complexity. The graduate of this program must be able to recognize the nature of value systems of patients and their families and be able to make ethical choices that are in the interest of their patients while maintaining their own ethical integrity. Pediatric endocrine fellows will include relevant case and statutory law in their decision-making and during their analysis and defense of their ethical choices. Pediatric endocrine fellows will be able to obtain valid consent and provide care when patients or families make poor judgments or refuse treatment. Pediatric endocrine fellows will be able to apply current ethical ideas in end-of-life care and in the care of individuals who are incapacitated or incompetent and unable to make their own decisions. Pediatric endocrine fellows will be able to recognize and effectively deal with unethical behavior in members of the healthcare team. Pediatric endocrine fellows will understand how to obtain additional help and be able to reach consensus when conflicts of opinions arise from ethical dilemmas. The pediatric endocrine fellow will recognize the diverse factors that influence the health of individuals in the community. They will be able to identify social, cultural, familial, psychological, economic, environmental, legal, political and spiritual factors that impact health care and health care delivery. They will respond to the social context created by these factors by planning and advocating the appropriate course of action at both the
  13. 13. individual and community level. They will develop zero tolerance for stereotypic language, racism, sexism, ageism, and aspersions to individuals or groups based on ethnic, religious and sexual preference or lifestyle choices. They will avoid identifying individuals by the name of their disease. They will understand all the reasons behind non-adherence. They will learn the benefits of being an advocate for better health for children in the community and understand the resources available in the community to provide ethnically- and gender-sensitive and culturally competent healthcare. 6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of, and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Graduates of this Pediatric Endocrine Fellowship will understand the various approaches to the organization, financing and delivery of health care. They will recognize threats to their own professionalism as posed by conflicts of interest inherent in financial and organizational arrangements. They will have the ability and vision to use new developments in technology and information systems to manage, problem-solve and make decisions that are relevant to the efficient and effective medical care of individuals and populations. They will learn to understand the context in which they practice and understand the interdependence between the patient care that they provide, that is provided by others and that is provided to the society at large. They will learn how to apply their knowledge to improve the care of individual patients and groups of patients as well as others in the health care system. They will learn to apply systematic and cost-effective strategies to prevent, diagnose and treat in a manner that never compromises quality of care. They will learn how to collaborate with other members of the team and their patients and families to coordinate care, to assist patients in dealing effectively with a complex system, and to improve systematic processes of care in an effort to improve outcomes. Whatever constraints are placed on the healthcare system, they will demonstrate their ability to remain a consummate advocate for the quality of care of the patient to whom they attend. They will learn how to use their leadership style, organizational chain of command, multi-tasking skills, and due process to best effect change that would lead to improved patient or practice environment outcomes. 7. Testing and Technical Skills All pediatric endocrine fellows will demonstrate competency in performing, using appropriate indications, contraindications and informed consent and evaluating the results of the testing procedures which include but are not limited to the following: provocative/stimulation tests of the GH/IGF-1 axis, the hypothalamic-pituitary- gonadotropin axis, the hypothalamic-pituitary-adrenal axis, the antidiuretic hormone system. Competence in all technical aspects of outpatient management of diabetes mellitus (blood sugar testing, insulin dosing and administration, glucagons administration, acute treatment of hypoglycemia and ketoacidosis) and emergency treatment of adrenal insufficiency is expected. Appropriate documentation of supervision, evaluation, and competence will be recorded and submitted by pediatric endocrine fellows at regular intervals during pediatric endocrine fellowship training.
  14. 14. 8. Self-Awareness, Self-Care and Personal Growth. Pediatric endocrine fellows shall become aware of their limitations, strengths, weaknesses, and personal vulnerabilities. They will assess their own personal values and priorities in order to develop and maintain an appropriate balance of personal and professional commitments and understand how the qualities and actions of their personal life can enhance their professional lives and vice versa. They will learn how to seek help and advice when needed for their own difficulties and develop appropriate personal coping strategies and mechanisms for stress-reduction. They will recognize how their actions affect others in their professional circle. They will learn how to seek, accurately review, and respond to performance feedback. They will learn how to take action in an effort to develop their own careers and achieve their own performance standards in either the academic or private sector. They will understand how to be a good citizen in organizations they join. They will learn how to integrate a program of personal good health and stress-reduction into their daily lives. Pediatric endocrine fellows will understand the concept that the education of the heart and their personal growth is at least as important as the education of their mind and professional growth. Revised: 12/2009 EndoFellowGoalsObjectives12-2009.doc