Program Requirements for Residency Education in Pediatric ...

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Program Requirements for Residency Education in Pediatric ...

  1. 1. 1 Program Requirements for Residency Education in Pediatric Endocrinology 2 3 Introduction 4 A. Scope of Training 5 1. Pediatric endocrinology programs must provide fellows with the ability 6 background to diagnose and manage endocrine diseases and to understand 7 the physiology of hormonal regulation in infancy, childhood, adolescence, 8 and young adulthood. 9 2. The program must emphasize fundamentals of clinical diagnosis, with 10 special emphasis on history taking, physical examination, and 11 interpretation of pertinent laboratory data. 12 VIII. Program Personnel and Resources 13 A. Faculty 14 1. Pediatric Endocrinology Specialists 15 A program must have at least two qualified pediatric endocrinologists, 16 inclusive of the program director. and ensure access to the full range of 17 pediatric subspecialists. 18 2. Other Physician Teaching and Consultant Faculty 19 In addition, The following physician faculty from other disciplines 20 appropriate consultant faculty and staff must be available: in related 21 disciplines, including surgery, obstetrics/gynecology, internal medicine, 22 child and adolescent psychiatry, nephrology, child neurology, as well as 23 the following physician faculty with significant experience in pediatrics: 24 surgery, neurosurgery, radiology, nuclear medicine, ophthalmology, 25 urology, and genetics. and diabetes education. 26 B. Facilities Resources 27 1. Outpatient and Inpatient Facilities 28 Facilities should include space in an ambulatory setting for optimal 29 evaluation and care of outpatients and an inpatient area with a full array of 30 pediatric and related services staffed by pediatric residents and faculty. 31 2. Laboratory/Support Services 32 Modern Facilities and services, including inpatient, ambulatory care, and 33 laboratory and comprehensive diagnostic imaging resources, must be Pediatric Endocrinology 1
  2. 2. 34 available and functioning. Specifically, a complete chemistry laboratory; 35 facilities for radioimmunoassay and karyotyping; nuclear, ultrasonic, and 36 radiologic imaging services that can conduct studies for all types of 37 endocrine disease; There must be a diabetes education service; a 38 nutrition/dietary education service; mental health services; endocrine 39 surgical services; and a pathology laboratory for the interpretations of 40 surgical and cytologic specimens, including immunohistologic studies. In 41 addition, there should be a close working relationship with dietary and/or 42 nutrition services. There must be the capacity for specialized hormone 43 measurements and genetic testing relevant to endocrine disorders either on 44 site or through established commercial laboratories. 45 3. Patient Population 46 There must be an adequate number of patients with endocrine disorders, 47 including diabetes, who range in age from newborn through young 48 adulthood, must be available to the training program to ensure that each 49 fellow achieves competence in patient care. 50 IX. Educational Program 51 A. Patient Care 52 1. Fellows must have a sufficiently diversified and complex endocrine 53 outpatient experience and adequate experience with inpatient 54 management. In particular, the pediatric endocrinology fellows must have 55 continuing responsibility for longitudinal care of patients with diabetes 56 mellitus and other chronic endocrine disorders. 57 2. Fellows must learn through patient care about normal and abnormal 58 hormonal regulation. The interaction of endocrine pathology and 59 psychosocial problems must be addressed. 60 3. The clinical experience must include, but not be limited to, the following: 61 a) Short stature, including constitutional delay Disorders of growth 62 b) Disorders of anterior pituitary hormone physiology, including 63 growth hormone deficiency 64 c) Disorders of posterior pituitary hormone physiology, including 65 diabetes insipidus 66 d) Disorders of hypothalamic hormonal regulation 67 e) Disorders of thyroid hormone physiology 68 f) Diagnosis and management of Endocrine neoplasia Pediatric Endocrinology 2
  3. 3. 69 g) Disorders of the adrenal gland physiology 70 h) Disorders of androgen and estrogen physiology metabolism, 71 including adolescent reproductive endocrinology 72 i) Disorders of sexual differentiation and development 73 j) Disorders of parathyroid gland physiology 74 k) Disorders of calcium, phosphorus, and vitamin D 75 l) Disorders of bone physiology metabolism 76 m) Disorders of fluid and electrolyte balance 77 n) Disorders of carbohydrate metabolism, including diabetes mellitus 78 and hypoglycemia 79 o) Disorders of nutrition, including eating disorders 80 p) Obesity including obesity related endocrine disorders (e.g. 81 polycystic ovarian syndrome, impaired glucose tolerance, 82 metabolic syndrome and type 2 diabetes) 83 4. Laboratory Experience 84 The residents must be instructed in the proper use of laboratory techniques 85 for measurement of hormones in body fluids. They must be taught to 86 recognize the limitations and pitfalls of interpretation of laboratory results. 87 All residents should be instructed in proper interpretation of endocrine 88 stimulation and suppression tests, including the normal variations that 89 occur in laboratory results at different ages and times of day. Residents 90 should be provided with a background that will enable them to utilize 91 current diagnostic procedures of endocrinology that involve radiology, 92 including ultrasonography, CT scanning and MRI, and nuclear medicine. 93 B. Medical Knowledge 94 1. Fellows must have instruction in: related clinical and basic sciences. These 95 include endocrine physiology, pathology, immunology, and biochemistry, 96 pharmacology; and embryology of endocrine and related systems 97 including with emphasis on sexual differentiation; genetics, including 98 laboratory methods, cytogenetics, and enzymology; and aspects of 99 immunology pertinent to understanding endocrine disease and the use of 100 immunoassays. 101 2. The fellows must understand the principles of laboratory techniques for 102 measurements of hormones. Fellows must be instructed in interpreting Pediatric Endocrinology 3
  4. 4. 103 endocrine laboratory results including stimulation and suppression tests. 104 Fellows should be provided with a background that will enable them to 105 choose the most appropriate imaging procedure(s) for a given endocrine 106 disorder. 107 3. In addition, regular conferences reviewing patient management must be 108 scheduled and attendance required of the subspecialty residents. Pediatric Endocrinology 4

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