Pediatric Endocrinology Training Program

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Welcome!

Our training program is hosted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH) located in Bethesda, Maryland and is supported through close collaboration with Children’s National Health System (CNHS) located in the District of Columbia metropolitan area as well as surrounding state-of-the-art facilities.

This unique fellowship combines exceptional clinical and research training in pediatric endocrinology over the course of the three years.  Note, individuals with Medicine-Pediatrics training can also be considered for a combined, 4 year dual program in Adult-Pediatric Endocrinology training.

During the first year, the fellows are mostly focused on acquiring and honing their clinical abilities, caring for a wide variety of patients in inpatient, outpatient, PICU, and NICU settings at the Children’s National Medical Center and NIH.  Children's National Health System is the premier provider of pediatric care in the Washington, DC, metropolitan area and is the only freestanding children's hospital in the region.  The division of endocrinology has an ADA recognized state of the art diabetes education program and is ranked as one of the top 10 endocrine division by US News and World Report in 2018-19.  In addition to general pediatric endocrinology and diabetes clinics, fellows participate in specialized multidisciplinary pediatric endocrine clinics for cancer survivors, bone health, Endo-gyn disorders, Disorders of sexual differentiation, obesity, lipid disorders, thyroid nodule and thyroid cancer, oncogenetics and transgender clinics and learn from well-trained diabetes educators about skills needed for insulin pump and CGM education.  The NIH offers the exquisitely unique opportunity to care for children with some of the most rare and complex endocrine disorders such as Cushing’s Syndrome, Lipodystrophy and McCune Albright Syndrome, just to name a few.  During the first year, fellows also obtain exposure to the various research labs and become oriented with the variety of research options available to them for their primary research projects.




During the second and third year, fellows continue to refine their clinical skills while engaging in stimulating research projects at NIH or CNMC.  NIH is the nation’s largest biomedical research facility with 27 institutes and centers all working together to make important discoveries that improve health. Fellows are encouraged to play leading roles in a wide variety of clinical, basic and /or translational research studies conducted at the NIH Clinical Center, a hospital dedicated solely to patient-oriented research with 240 inpatient beds, 11 operating rooms, 82 day hospital stations, critical care services and research labs, an ambulatory care research facility, and a complex array of imaging services.  In addition to the NIH research community, our fellows take advantage of the CNHS research community.  Home to the Children’s Research Institute (CRI) and the Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National is one of the nation’s top NIH-funded pediatric institutions. CNHS offers innumerable opportunities to participate in cutting-edge basic science and translational research in multiple areas relevant to pediatric endocrinology. Funding for 2 years of research is guaranteed to all accepted fellows and these years are devoted to heavily protected research time.


Continuity of clinical care and education:  Fellows have one half day continuity clinic each week (alternating between NIH and CNMC) throughout their 3 years of training supervised by a faculty preceptor.  Fellows participate and conduct numerous clinical conferences and Journal clubs and are provided didactics covering the full array of endocrine and diabetes topics as well as board preparation on a regular basis.  Fellows also receive appropriate courses on statistics, biotechnology and laboratory methods, grant and scientific paper writing, and the development and execution of clinical trials throughout their 3 years of training.


The fellowship is designed to foster the development of academic pediatric endocrinologists who will become leaders and researchers in this field. The fellowship program is ACGME-accredited and leads to board eligibility for the Pediatric Endocrinology Sub-Board of the American Board of Pediatrics. It is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).


Non-competitive Loan repayment is available through the noncompetitive intramural NIH LRP

LRP website link: https://www.lrp.nih.gov


Applications are accepted through ERAS: https://www.aamc.org/services/eras/

(Interviews generally available on Thursdays throughout Aug-October; Tele-hosted interviews will be considered)


Annual reports of the distinguished group of individuals who constitute our NIH teaching and research faculty are available at  http://annualreport.nichd.nih.gov/index.html 

Further information on Children's National is available at https://childrensnational.org &  https://childrensnational.org/departments/endocrinology-and-diabetes


Curriculum

NICHD Pediatric Endocrinology Training Program Fellowship Program


Curriculum and evaluation methods

The following document represents a defined educational program or curriculum, which has been established as a guide for trainees in Pediatric Endocrinology. It addresses the six competency areas: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. It is developed with the goal of instilling the capacity for and interest in life-long learning, and is in accordance with the Program Requirements on Pediatric Endocrinology approved by ACGME in 2008. It is also adapted to the specific needs educational goals, objectives and resources of the NIH.  The curriculum was revised in June 2011 in response to the ACGME site visit recommendations. 

Sites of clinical training:  NIH Clinical Center, Bethesda Maryland; CNHS Children's Hospital, District of Columbia, Walter Reed National Military Medical Center, Bethesda Maryland; Optional Electives:  Johns Hopkins Children's Hospital, Baltimore, Maryland, Georgetown University Hospital, District of Columbia


Part I: Summary of Principle Learning Goals, and Objectives and Education Methodology of the Program by Relevant ACGME Competency Domain

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1. Patient Care

Principle Educational Goals

A. Technical Skills

The Fellow will master the technical skills relevant for the practice of pediatric endocrinology. These skills include, as a minimum, the following: detailed physical assessment and analysis of patients and their laboratory data, interpretation of special physical features, interpretation of molecular and other diagnostic tests, appropriate counseling for both individuals and families, performance of certain procedures, extraction of relevant clinical information from a patient’s medical record.

B. Clinical Consultation

The Fellow will learn to provide appropriate and effective and timely consultation to clinicians and other health care providers. Consultation will, as a minimum, include providing a diagnosis, discussing the implications of a diagnosis in the management of a patient, providing advice regarding ordering of additional diagnostic tests, assisting in the interpretation of results, or offering counseling strategies for family members.

Learning Activities

Direct Patient Care, Attending rounds

Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Written evaluations are prepared by the attending each month and are reviewed with the fellow. Fellows have the opportunity to discuss and respond to these reviews at the time of the evaluation. On outside rotations at Georgetown University Hospital, Johns Hopkins University, and Children's National Medical Center, rotations are generally 6-8 weeks in duration. At the end of each rotation, each fellow meets with the physician in charge of training at each of these institutions for an oral evaluation. Written evaluations of each trainee are completed by the attending staff following each rotation on competency based evaluation forms (E*value). Although they are available on-line, these forms are also printed out by the pediatric fellowship office on a bi-annual basis and each fellow is required to read their evaluations and initial each one. The evaluations are discussed with the fellow in bi-annual meetings with the program director that occur in Dec/Jan and June/July with all of the trainees. In addition, a yearly formal evaluation is prepared by the program director, based in part on these evaluations. This report is discussed with the fellow by the program director during the June/July meeting, and with other attending staff as necessary, and is kept in the resident file. A final, summary evaluation is prepared at the end of the 3-year program for each graduating fellow by the program director. This is presented to the fellow and discussed with him/her during the last June meeting with the Program Director. The fellow and program director sign the document, which remains in the permanent file of the resident maintained by the program. Objective metrics include the performance on the in-service training exam, as well as thorough critique of their presentations, clinical judgment, skills at history and physical examination, differential diagnosis, and the scope of their approach to pediatric endocrine problems.

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2. Medical Knowledge

Principle Educational Goals

A.  Fund of Medical Knowledge

The Fellow will develop a fund of general medical knowledge and focused endocrine knowledge relevant to the competent practice of pediatric endocrinology. This fund of knowledge will include, but not be limited to, an understanding of basic concepts of endocrine disease; the pathophysiology of the endocrine system, the epidemiologic, clinical, morphologic, biochemical and/or genetic features of endocrine disorders, and the social impact of certain endocrine diseases (for example pediatric obesity). Fellows are expected to read the current literature relevant to each patient.

B. Application of Medical Knowledge in the Practice of Pediatric Endocrinology

The Fellow will learn to effectively apply his/her general and focused medical knowledge in the day-to-day practice of Pediatric Endocrinology. The Fellow must be able to apply his/her knowledge of the diagnostic, prognostics and general therapeutic features of both common and rare disorders to analyze clinical situations, construct a reasonable differential diagnosis, establish a definite diagnosis, and discuss the prognostic and general therapeutic implications of a disorder with clinicians and patients.

Learning Activities

Direct Patient Care, Clinical Conferences, Courses, Case presentations

Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self

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3. Practice-based Learning and Improvement

Principle Educational Goals

A. Evidence-Based Practice

The Fellow will learn to make effective use of conferences, lectures and reading of the medical literature (texts, journals, and medical/genetic databases) to inform his/her day-to-day practice of Pediatric Endocrinology, and in the development and resolution of a differential diagnosis.

The Fellow must develop the ability to critically evaluate the quality of research studies and to be discriminating in the selection of information sources used to support medical decision-making.

B. Use of Information Technology

The Fellow will learn to use a variety of information technologies to inform and improve his/her day-to-day practice of Pediatric Endocrinology. Examples of information technologies that must be mastered include electronic medical literature databases, internet-based information sources such as computer-based resources (CD’s and other media) and the PubMed and other search engines (OMIM etc.)

Learning Activities

Direct Patient Care, Ethics Conference, Clinical Case Conference, GMEC core competencies workshops, grand rounds

Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director

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4. Interpersonal and Communication Skills

Principle Educational Goals

A. Communication Skills

The Fellow will learn to communicate effectively and appropriately with health care providers, laboratory and staff members, administrators, patients and other individuals in the course of his/her practice. These communications will include verbal (face-to-face and telephone conversations) and written (written reports, letters, email messages etc.) formats. The Fellow must strive to communicate in a clear, concise, accurate and focused manner. The Fellow must develop and practice skill in counseling patients and their families regarding their disease. The Fellow must be able to communicate on both an emotional and informational level when caring for patients facing a crisis. Regarding the production of written reports, the ultimate goal is for the Fellow to produce, essentially, letter-perfect reports that require minimal or no modification by the attending and that convey essential diagnostic information in a clear, understandable manner.

B. Teamwork

The resident will learn to work as an effective member of the health care team in the course of his/her daily practice. The resident must strive to perform his/her tasks in a responsible and timely fashion, facilitate the tasks of other team members and be cooperative in his/her interactions with team members. Team members may include other residents, attending geneticists, consultants, clinicians, administrators, technicians and others.

Learning Activities

Direct Patient Care, Multidisciplinary/QA rounds, written reports and letters, GMEC core competencies workshops, grand rounds

Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self

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5. Professionalism

Principle Educational Goals

A. Courtesy and Collegiality

The Fellow must learn to treat health care providers (including clinicians, nurses, counselors, other endocrinologists etc.), administrators, patients and others courteously and respectfully. The Fellow must learn to be collegial in all interactions with other members of the health care team.

B. Professional Responsibility

The Fellow must learn to take his/her professional responsibilities seriously and act accordingly. The latter may include clinical service (including on-call responsibilities), teaching, administrative tasks, research, institutional tasks, and work with professional organizations. The Fellow should strive to approach each of these responsibilities with enthusiasm and complete all tasks and assignments effectively and in a timely fashion.

Learning Activities

Direct Patient Care, Attending Rounds, GMEC core competencies workshops

Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member

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6. Systems-Based Practice

Principle Educational Goals

A. The Health Care System and the Role of Pediatric Endocrinology

The Fellow must acquire knowledge of practice and health care delivery systems and an awareness of the role of pediatric endocrinologists in the context of the greater health care system. The Fellow will develop a working knowledge of different inpatient and outpatient healthcare delivery systems and the general regulatory and financial aspects of healthcare delivery. The Fellow must learn the importance of providing effective and timely consultation to clinicians, advising healthcare providers in the provision of cost-effective care, while cognizant and in accord with patient privacy and confidentiality. The Fellow should learn to provide statistical and other relevant data, as needed, in support of quality care, and the Institution.

B. General Laboratory Administration

The Fellow will develop an understanding of the general administrative aspects of Pediatric Endocrinology Practice and will learn to understand and apply the principles of quality control, quality assurance, and continuous quality improvement. The Fellow will develop a working knowledge of laboratory skills, report generation, and safe genetic diagnostic laboratory practice.

Learning Activities

Direct Patient Care, GMEC core competencies workshops, grand rounds

Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director


The graduate medical education committee (GMEC) at the NIH initiated an institutional core curriculum in 2010 modeled after the GMEC subcommittee on competency-based curriculum and assessment. The core curriculum aims to address professionalism, interpersonal and communication skills, and system-based practice for all fellows at the Clinical Center. While the clinical center-wide grand rounds in August of each year address these competencies, our institution as a whole is initiating a program to provide active-learning opportunities for these competencies. In order to address this challenge, the GMEC initiated roundtable discussions, video presentations and scenario workshops on such topics as effective communication, quality improvement, and elements of successful informed consent, cross cultural medicine, resolving conflict, and death and dying. These sessions are led by experts in the Clinical Center, including psychiatrists, social workers, staff from the Office of the Ombudsmen, and palliative care physicians. In addition, simulation and objective structured clinical examination (OSCE) sessions with actors on gaining informed consent, communicating adverse outcomes, and facilitating end of life conversations are were initiated during the 2010-2011 academic year. Our fellows are required to complete the online LIFE curriculum (Learning to address Impairment ad Fatigue to enhance patient safety, developed collaboratively by Duke University Hospital, the UNC Hospitals, the NC AHEC, and the NC Physician's Health Program). These modules address various topics related to physician impairment, professionalism, interpersonal and communication skills, and systems based practice.

At the conclusion of the program, the graduating Fellow in Pediatric Endocrinology should:

  1. Have developed an understanding of basic Pediatric Endocrine disease processes
  2. Have acquired skills needed to interpret laboratory data and make correlations facilitating clinical diagnoses
  3. Be able to communicate effectively with peers in Pediatric Endocrinology, clinical colleagues, patients and their families
  4. Have developed investigational skills to better understand Pediatric Endocrine processes as they apply to both individual patients and the general patient population
  5. Have acquired knowledge of the tools needed to generate laboratory diagnoses
  6. Have demonstrated the potential for professional growth, with the ability to pursue life-long learning
  7. Have demonstrated competency to function as a subspecialist in Pediatric Endocrinology
  8. Have completed and successfully passed all coursework and exams in required didactic courses
  9. Have achieved high pass grades in annual training examinations


At the conclusion of the program, the graduating Fellow should have acquired the following skills:

  1. Be able to obtain pertinent information from the patient and by critical review of the patient’s clinical record
  2. Demonstrate knowledge of information that is necessary to provide adequate clinical history on submission forms for diagnostic testing
  3. Demonstrate proficiency in disease counseling and risk assessment
  4. Describe and appropriately select diagnostic tests for a variety of common and rare endocrine disorders
  5. Describe appropriate and effective management and care for a variety of common and rare endocrine disorders

Part II: Specific Competency Based Goals and Objectives by Rotation Assignment and Year/Level of Training

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A. Year 1

Summary of Rotation Assignments in Year 1

  1. Continuity Clinic NIH: 6 months
  2. NIH inpatient Pediatric/Adult Endocrinology Service: 6 months
  3. Children’s National Medical Center rotation: 4 months
  4. Georgetown University rotation: 1 months
  5. Johns Hopkins (JHU) rotation: 1 months

Summary of Program Expectations/Outcomes for Year 1/Skill Level 1

By the completion of Year1/Skill level 1, -Achieved by the successful 1st year Fellow will:

  • Demonstrate competent physical assessment skills
  • Demonstrate competent pedigree construction skills
  • Demonstrate scholarly written reports and letters
  • Demonstrate compassionate and understandable patient/family management
  • Demonstrate ability to identify and order appropriate and correct laboratory diagnostics
  • Demonstrate ability to accomplish case presentations with appropriate computer equipment
  • Demonstrate ability to interpret research papers and present in journal club
  • Have taken and achieved a passing grade in in-training examination
  • Demonstrate sufficient clinical judgment and proficiency to permit care of patients with more complex disorders under supervision of the faculty

Specific Competency Based Goals and Objectives By Rotation Assignment in Year 1

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1. NIH inpatient Pediatric/Adult Endocrinology Service

The goals and objectives of the rotations in NIH inpatient/Adult endocrinology are:

a. Gain experience in the diagnosis, management, and counseling of individuals with a variety of mostly rare and/or genetic endocrine disorders
b. Develop medical history taking skills relevant to children with known or suspected endocrine disorders
c. Refine clinical assessment skills; analyze biochemical data
d. Acquire skills in performing physical examination focusing on the endocrine system
e. Develop knowledge base to enable generation of differential diagnosis
f. Understand and manage the immediate sequelae of abnormal laboratory results
g. Recognize and implement care plans for acute metabolic emergencies.
h. Counsel individuals and families regarding test results, prognosis, and possible therapeutic interventions.
i. Develop skills in helping people cope with difficult news or bereavement issues.
j. Participate in interdisciplinary medical teams caring for patients to communicate disease-related issues to families and other care providers.

Competency 1: Patient Care

Provide clinical care in the area of Pediatric Endocrinology to patients/families.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder; take detailed measurements

Direct patient care, faculty supervision

Identify, explain and provide initial management and support for a variety of endocrine and/or metabolic conditions (see detailed curriculum)

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential metabolic emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Participate in sessions with patients and families

Direct patient care; faculty supervision;

Write letters to patients/families

Direct patient care; faculty supervision;

Communicate effectively with physicians, other team staff to create and sustain information exchange for patient care;
maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances

Journal Club, attend rounds and clinical conferences,

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education



Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood, providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to the well being of all patients, your own and consults, and follow --up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

Principal Educational Objectives

Learning Activities

Identify written and internet resources to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Identify other protocols for patients’ possible participation and facilitate enrollment, complete informed consent

Direct patient care, faculty supervision

Recognize and advocate for families who need assistance to deal with burdens of protocol participation or complexities of research system

Direct patient care


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director


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Competency 1: Patient Care

Provide clinical care in the area of Pediatric Endocrinology to patients/families.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential endocrine emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential endocrine disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Participate in genetic counseling sessions for endocrine disorders

Direct patient care; faculty supervision;

Write letters to patients/families which discuss sensitive issues related to the condition

Direct patient care; faculty supervision;

Communicate effectively with physicians, other team staff to create and sustain information exchange for patient care; maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances in the understanding of endocrine disorders in order to incorporate into one’s practice improved screening, identification, counseling and management of these disorders

Journal Club, attend rounds and clinical conferences,

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education conferences

Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood, providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to the well being of all patients, your own and consults, and follow--up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

 

Principal Educational Objectives

Learning Activities

Identify written and internet resources to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Recognize and advocate for patients who need assistance to deal with burdens of disease and care

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director

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3. Children’s National Medical Center rotation: 4-6 months

Pediatric endocrine fellows rotate for approximately 5 months at CNMC during thier first year. They participate in outpatient clinics, and also are responsible for the consult service and inpatient admissions. The fellows have the opportunity to care for patients with diabetes, thyroid disorders, growth abnormalities, and various other endocrine problems that are not necessarily covered frequently at the NIH Clinical Center.

The goals and objectives of the rotation are:

a. Obtain experience in common pediatric endocrine disease and routine physical examination
b. Develop an accurate differential diagnosis and plan a diagnostic work-up
c. Learn laboratory assessment skills for individuals with common endocrine disorders and become familiar with their treatment

Competency 1: Patient Care

Provide clinical care in the area of Pediatric Endocrinology to patients/families.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential endocrine emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential endocrine disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Participate in genetic counseling sessions for endocrine disorders

Direct patient care; faculty supervision;

Write letters to patients/families which discuss sensitive issues related to the condition

Direct patient care; faculty supervision;

Communicate effectively with physicians, other team staff to create and sustain information exchange for patient care;
maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances in the understanding of endocrine disorders in order to incorporate into one’s practice improved screening, identification, counseling and management of these disorders

Journal Club, attend rounds and clinical conferences,

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education conferences

Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood,
providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to the well being of all patients, your own and consults, and follow--up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

 

Principal Educational Objectives

Learning Activities

Identify written and internet resources to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Recognize and advocate for patients who need assistance to deal with burdens of disease and care

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director


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4. Johns Hopkins (JHU) rotation-1 month elective

This experience provides training in clinical pediatric endocrinology. The fellow attends the outpatient clinics of the pediatric endocrine faculty. This includes numerous general pediatric endocrine clinics, the pediatric diabetes clinic, and a pediatric bone disease clinic. Through these clinics, the fellow is exposed to the full range of both new patient referrals to pediatric endocrinology as well as the full range of pediatric endocrine disorders followed longitudinally as outpatients. The fellow also manages the pediatric endocrine inpatient and consult service. This provides exposure to the full range of inpatient pediatric endocrinology.

The goals and objectives of this month rotation in a large academic but general hospital center are:

a. Obtain experience in common pediatric endocrine disease and routine physical examination
b. Develop an accurate differential diagnosis and plan a diagnostic work-up in an urban setting and with a highly diverse population of patients.
c. Learn laboratory assessment skills for individuals with common endocrine disorders and become familiar with their treatment

Competency 1: Patient Care

Provide clinical care in the area of Pediatric Endocrinology to patients/families.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential endocrine emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential endocrine disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Participate in genetic counseling sessions for endocrine disorders

Direct patient care; faculty supervision;

Write letters to patients/families which discuss sensitive issues related to the condition

Direct patient care; faculty supervision;

Communicate effectively with physicians, other team staff
to create and sustain information exchange for patient care; maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances in the understanding of endocrine disorders in order to incorporate into one’s practice improved screening, identification, counseling and management of these disorders

Journal Club, attend rounds and clinical conferences,

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education conferences

Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood,
providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to the well being of all patients, your own and consults, and follow--up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

 

Principal Educational Objectives

Learning Activities

Identify written and internet resources
to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Recognize and advocate for patients who need assistance to deal with burdens of disease and care

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director


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5. Continuity Clinic NIH – 36 months

Each Tuesday of the first year (with the exception of the months while fellows are rotating at Children’s National Medical Center), first year fellows participate in the weekly pediatric endocrine continuity clinic. In this clinic, first year fellows see patients with a variety of common as well as rare pediatric endocrine disorders. The fellows are expected to review pertinent past records ahead of time, to see the patient independently and then meet with the attending to present the case. The fellow then returns to the patients’ room with the attending to go over the history and exam, and the fellow is expected to explain the plan of care to the family and patient with the attending present. In addition, the first year fellow is expected to follow up on laboratory and imaging results with the patient’s family and the attending, and to dictate a note as well as a letter to the referring MD. The patients seen in continuity clinic are then discussed at the Tuesday afternoon post-clinic educational conference, in which the teaching attending of the month leads a discussion of the most interesting cases and asks the fellows to present their patients.

Goals and objectives of the continuity clinic during the first year of training are:

  1. To perform a comprehensive history and physical examination on pediatric outpatients with endocrine disorders
  2. To present the case to the pediatric endocrine attending and to the team in post-clinc conference
  3. To review relevant evidence-based literature to guide decision making
  4. To order and review tests and imaging studies when appropriate
  5. To take responsibility for communicating results and plan of care with families and referring physicians


Competency 1: Patient Care

Provide clinical care in the area of Pediatric Endocrinology to patients/families.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential endocrine emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential endocrine disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Participate in genetic counseling sessions for endocrine disorders

Direct patient care; faculty supervision;

Write letters to patients/families which discuss sensitive issues related to the condition

Direct patient care; faculty supervision;

Communicate effectively with physicians, other team staff
to create and sustain information exchange for patient care; maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances in the understanding of endocrine disorders in order to incorporate into one’s practice improved screening, identification, counseling and management of these disorders

Journal Club, attend rounds and clinical conferences,

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education conferences

Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood,
providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to the well being of all patients, your own and consults, and follow--up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

 

Principal Educational Objectives

Learning Activities

Identify written and internet resources
to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Recognize and advocate for patients who need assistance to deal with burdens of disease and care

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director

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B. Year 2

Summary of Rotation Assignments in Year 2

  1. Laboratory or clinical research project-all months
  2. Clinical Consult service-3 months
  3. Outpatient service (continuity clinic)-all months

Summary of Program: Expectations Outcomes for Year 2

By the completion of Year 2, the successful 2nd year Fellow will:

  • Present their research at the Friday research conference for the Section on Developmental Endocrinology and Genetics
  • Formulate a research question and have made significant progress towards their scholarly work product
  • Presented their progress in research to their scholarship oversight committee
  • Demonstrate knowledge of laboratory methods
  • Demonstrate knowledge of molecular/biochemical tests used for common and rare disorder diagnosis and screening
  • Demonstrate proficiency in physical examination and testing interpretation
  • Demonstrate ability to take care of a patient effectively and independently
  • Demonstrate knowledge of common and rare disorders and methods of diagnosis
  • Take and pass the General Pediatrics Boards Examination
  • Take and achieve a passing grade in the in-training examinations
  • Take and achieve a passing grade in the Principles and Practice of Clinical Research course offered by the NIH Clinical Center
  • Begin a clinical or bench research project
  • Take grant-writing classes and participate in other recommended (by the PD and faculty) educational activities

 

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Principle Educational Goals by Relevant Competency Outcomes Expected of Year 2 by Rotation Assignment

1. Laboratory or clinical research project

Goals and objectives include the following:

  1. To gain familiarity with fundamentals of molecular biology and clinical research
  2. To demonstrate knowledge of the range of methods routinely used for clinical diagnosis
  3. To demonstrate the ability to search the scientific literature to critically assess the development of new tests
  4. To observe and perform tests in clinical or molecular endocrinology, including PCR and Southern blot analysis
  5. To gain the ability to communicate with requesting physicians and counsel them on the appropriate use of molecular and/or other related diagnostic testing
  6. To demonstrate ability to review and interpret molecular results
  7. To demonstrate understanding of issues of quality control, quality assurance, cost-effectiveness, and laboratory management
  8. To learn techniques to prepare samples (blood, urine)
  9. To learn to isolate DNA
  10. To earn proper handling of patient samples in a CLIA certified laboratory.
  11. To learn how to design and interpret experiments
  12. To obtain good knowledge of statistics and its application in interpreting laboratory and clinical data

1. Patient Care

Principal Educational Objectives

Learning Activities

Appropriately evaluate and manage samples for diagnostic testing or analysis.

Observation and role modeling handling and processing samples for testing

Learn to use the results of testing or analysis to improve patient care by better management and counseling

Observation and role modeling handling and processing samples for testing


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self


Competency 2: Medical Knowledge

Principal Educational Objectives

Learning Activities

Gain familiarity with specific techniques for individual conditions and specific assays for analysis.

Assigned and Independent Reading, Journal Club, Board Review Classes conference and rounds.

Assess and critically evaluate current medical literature and scientific evidence relevant to clinical laboratory medicine in endocrinology

Assigned and Independent Reading, Journal Club, Board Review Classes

Gain experience in formulating research question and presenting research results to peers and attending

Scholarship oversight committee meetings


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

Scholarship oversight committee meetings

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Principal Educational Objectives

Learning Activities

Communicate effectively with patients, families, colleagues, and laboratory team members.

Direct patient care; faculty supervision
Conference, written assignments

Communicate effectively and accurately in written reports of laboratory results.

Direct patient care; faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Principal Educational Objectives

Learning Activities

Identify and acknowledge gaps in knowledge and skills in the genetic diagnostic laboratory

Assigned and Independent Reading, Journal Club, QA meetings
Attend Introduction to Principles and Practice of Clinical Research course


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

5. Professionalism

Principal Educational Objectives

Learning Activities

Behave professionally towards patients, families, colleagues, and all members of the health care team

Attendance at rounds; meet with patient and faculty supervisor to review testing result


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self


Competency 6: Systems-Based Practice

6. Systems-Based Practice

Principle Educational Goals

 

Principal Educational Objectives

Learning Activities

Effectively utilize the resources available to assure high quality laboratory data, use accurate measurements and standards

Conferences, IPPCR course


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self


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2. Clinical Consult service

The goals and objectives during the 2nd year are:

a. Manage common pediatric endocrine disease and routine physical examination
b. Develop an accurate differential diagnosis and plan a diagnostic work-up.
c. Learn laboratory assessment skills for individuals with common endocrine disorders and become familiar with their treatment

Competency 1: Patient Care

Provide clinical care to patients/families who are either affected or potentially affected by a pediatric endocrine condition.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder, and communicate with team requesting consult

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential endocrine emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential endocrine disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Communicate effectively with physicians, other team staff
to create and sustain information exchange for patient care;
maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances in the understanding of endocrine disorders in order to incorporate into one’s practice improved screening, identification, counseling and management of these disorders

Journal Club, attend rounds and clinical conferences, QA meeting

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education conferences

Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood,
providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to
the well being of all patients, your own and consults, and follow--up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

 

Principal Educational Objectives

Learning Activities

Identify written and internet resources
to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Recognize and advocate for patients who need assistance to deal with burdens of disease and care

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director


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3. Outpatient service (continuity clinic)-all months

Each Tuesday of the fellow’s second year, 2nd year fellows participate in the weekly pediatric endocrine continuity clinic. In this clinic, second year fellows see patients with a variety of common as well as rare pediatric endocrine disorders, with an increasing level of responsibility. The fellows are expected to review pertinent past records ahead of time, to see the patient independently and then meet with the attending to present the case. The fellow then returns to the patients’ room with the attending to go over the history and exam, and the fellow is expected to explain the plan of care to the family and patient with the attending present. In addition, the second year fellow is expected to follow up on laboratory and imaging results with the patient’s family and the attending, and to dictate a note as well as a letter to the referring MD. The patients seen in continuity clinic are then discussed at the Tuesday afternoon post-clinic educational conference, in which the teaching attending of the month leads a discussion of the most interesting cases and asks the fellows to present their patients. What distinguishes the role of the 1st from the 2nd year fellows in continuity clinic is the number of patient seen (2nd year fellows are assigned up to 6 patients per morning session). Second year fellows are expected to see continuity clinic patients in an efficient yet thorough manner, and to take responsibility of formulating their own plan of care and differential diagnosis prior to seeking the attending’s advice.

Goals and objectives of the continuity clinic during the second year of training are:

  1. To perform a comprehensive history and physical examination on pediatric outpatients with endocrine disorders
  2. To present the case to the pediatric endocrine attending and to the team in post-clinc conference
  3. To review relevant evidence-based literature to guide decision making
  4. To order and review tests and imaging studies when appropriate
  5. To take responsibility for communicating results and plan of care with families and referring physicians


Competency 1: Patient Care

Provide clinical care in the area of Pediatric Endocrinology to patients/families.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential endocrine emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential endocrine disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Participate in genetic counseling sessions for endocrine disorders

Direct patient care; faculty supervision;

Write letters to patients/families which discuss sensitive issues related to the condition

Direct patient care; faculty supervision;

Communicate effectively with physicians, other team staff
to create and sustain information exchange for patient care; maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances in the understanding of endocrine disorders in order to incorporate into one’s practice improved screening, identification, counseling and management of these disorders

Journal Club, attend rounds and clinical conferences,

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education conferences

Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood,
providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to the well being of all patients, your own and consults, and follow--up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

 

Principal Educational Objectives

Learning Activities

Identify written and internet resources
to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Recognize and advocate for patients who need assistance to deal with burdens of disease and care

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director


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C. Year 3

Summary of Rotation Assignments in Year 3 

  1. Laboratory/Clinical research project-all months
  2. Clinical Consult service and teaching month-3 months
  3. Outpatient service (continuity clinic)-all months

Summary of Program Expectations Outcomes for Year 3

By the completion of Year 3, the Fellow graduate will:

  • Demonstrate knowledge of laboratory methods
  • Demonstrate knowledge of molecular/biochemical tests used for common and rare disorder diagnosis and screening
  • Demonstrate proficiency in physical examination and testing interpretation
  • Demonstrate ability to take care of a patient effectively and independently
  • Demonstrate knowledge of common and rare disorders and methods of diagnosis
  • Take and achieve a passing grade in the in-training examinations
  • Take and achieve a passing grade in the Principles and Practice of Clinical Research course offered by the NIH Clinical Center
  • Complete a clinical or bench research project
  • Take grant-writing classes and participate in other recommended (by the PD and faculty) educational activities
  • Serve for one month as the “teaching attending in training” in the NIH endocrine wards
  • Demonstrating independence in clinical care and academic activities.


Principle Educational Goals by Relevant Competency Outcomes Expected of Year 3 by Rotation Assignment

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1. Laboratory or clinical research project

Goals and objectives include the following:

  1. To gain familiarity with fundamentals of molecular biology and clinical research
  2. To demonstrate knowledge of the range of methods routinely used for clinical diagnosis
  3. To demonstrate the ability to search the scientific literature to critically assess the development of new tests
  4. To observe and perform tests in clinical or molecular endocrinology, including PCR and Southern blot analysis
  5. To gain the ability to communicate with requesting physicians and counsel them on the appropriate use of molecular and/or other related diagnostic testing
  6. To demonstrate ability to review and interpret molecular results
  7. To demonstrate understanding of issues of quality control, quality assurance, cost-effectiveness, and laboratory management
  8. To learn techniques to prepare samples (blood, urine)
  9. To learn to isolate DNA
  10. To earn proper handling of patient samples in a CLIA certified laboratory.
  11. To learn how to design and interpret experiments
  12. To obtain good knowledge of statistics and its application in interpreting laboratory and clinical data
  13. To present their research project at the Section’s research conference, national meetings, and at their Scholarly Oversight Committee meetings.

1. Patient Care

Principal Educational Objectives

Learning Activities

Appropriately evaluate and manage samples for diagnostic testing or analysis.

Observation and role modeling handling and processing samples for testing

Learn to use the results of testing or analysis to improve patient care by better management and counseling

Observation and role modeling handling and processing samples for testing


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self


Competency 2: Medical Knowledge

Principal Educational Objectives

Learning Activities

Gain familiarity with specific techniques for individual conditions and specific assays for analysis.

Assigned and Independent Reading, Journal Club, Board Review Classes conference and rounds.

Assess and critically evaluate current medical literature and scientific evidence relevant to clinical laboratory medicine in endocrinology

Assigned and Independent Reading, Journal Club, Board Review Classes

Gain experience in formulating research question and presenting research results to peers and attendings

Scholarship oversight committee meetings


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

Scholarship oversight committee meetings

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Principal Educational Objectives

Learning Activities

Communicate effectively with patients, families, colleagues, and laboratory team members.

Direct patient care; faculty supervision
Conference, written assignments

Communicate effectively and accurately in written reports of laboratory results.

Direct patient care; faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Principal Educational Objectives

Learning Activities

Identify and acknowledge gaps in knowledge and skills in the genetic diagnostic laboratory

Assigned and Independent Reading, Journal Club, QA meetings
Attend Introduction to Principles and Practice of Clinical Research course


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

5. Professionalism

Principal Educational Objectives

Learning Activities

Behave professionally towards patients, families, colleagues, and all members of the health care team

Attendance at rounds; meet with patient and faculty supervisor to review testing result


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self


Competency 6: Systems-Based Practice

6. Systems-Based Practice

Principle Educational Goals

 

Principal Educational Objectives

Learning Activities

Effectively utilize the resources available to assure high quality laboratory data, use accurate measurements and standards

Conferences, IPPCR course


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self


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2. Clinical Consult service

The goals and objectives during the 3rd year for the consult service are:

a. Critically assess patients in whom an endocrine consultation has been requested via review of pertinent history and physical examination.
b. develop an accurate differential diagnosis and plan a diagnostic work-up.
c. Learn laboratory assessment skills for individuals with common endocrine disorders and become familiar with their treatment
d. To work towards becoming an independent pediatric endocrinologist by coming up with the differential diagnosis and plan of care prior to seeking advice from the teaching attending
e. One month towards the end of the fellow’s third year is spent not only on the consult service, but also serving as the “teaching attending in training.” Through this role, the 3rd year fellow leads the Wednesday teaching rounds for the first-year fellows and takes primary responsibility for mentoring the 1st year fellows, while the attending of the month is available as back-up.


Competency 1: Patient Care

Provide clinical care to patients/families who are either affected or potentially affected by a pediatric endocrine condition.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder, and communicate with team requesting consult

Direct patient care, faculty supervision

Provide teaching and mentoring to 1st year fellows

“teaching attending in training” month with responsibility for leading Wednesday rounds


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self
1st year fellows

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential endocrine emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential endocrine disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Communicate effectively with physicians, other team staff
to create and sustain information exchange for patient care;
maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances in the understanding of endocrine disorders in order to incorporate into one’s practice improved screening, identification, counseling and management of these disorders

Journal Club, attend rounds and clinical conferences, QA meeting

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education conferences

Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood,
providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to
the well being of all patients, your own and consults, and follow--up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

 

Principal Educational Objectives

Learning Activities

Identify written and internet resources
to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Recognize and advocate for patients who need assistance to deal with burdens of disease and care

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director


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3. Outpatient service (continuity clinic)-all months

Each Tuesday of the fellow’s third year, 3rd year fellows participate in the weekly pediatric endocrine continuity clinic. In this clinic, third year fellows see patients with a variety of common as well as rare pediatric endocrine disorders, with an increasing level of responsibility. The fellows are expected to review pertinent past records ahead of time, to see the patient independently and then meet with the attending to present the case. The fellow then returns to the patients’ room with the attending to go over the history and exam, and the fellow is expected to explain the plan of care to the family and patient with the attending present. In addition, the second year fellow is expected to follow up on laboratory and imaging results with the patient’s family and the attending, and to dictate a note as well as a letter to the referring MD. The patients seen in continuity clinic are then discussed at the Tuesday afternoon post-clinic educational conference, in which the teaching attending of the month leads a discussion of the most interesting cases and asks the fellows to present their patients. Third year fellows are expected to see continuity clinic patients in an efficient yet thorough manner, and to take responsibility of formulating their own plan of care and differential diagnosis prior to seeking the attending’s advice. Towards the end of their 3rd year, fellows gain increasing independence in the continuity clinic and rely less on the attendings for help with patient management decisions.

Goals and objectives of the continuity clinic during the 3rd year of training are:

  1. To perform a comprehensive history and physical examination on pediatric outpatients with endocrine disorders
  2. To present the case to the pediatric endocrine attending and to the team in post-clinc conference
  3. To review relevant evidence-based literature to guide decision making
  4. To order and review tests and imaging studies when appropriate
  5. To take responsibility for communicating results and plan of care with families and referring physicians
  6. To transition to taking independent responsibility for patient care

Competency 1: Patient Care

Provide clinical care in the area of Pediatric Endocrinology to patients/families.

Principal Educational Objectives

Learning Activities

Obtain and document medical history including a detailed prenatal and family history

Direct patient care, faculty supervision

Perform and document thorough physical examination on a child with suspected endocrine disorder

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Patient Care

Direct observation

Faculty Member
Patient/Family Member
Program Director
Self

Patient Care

Global assessment

Faculty Member
Program Director
Self

Patient Care

Multisource assessment

Faculty Member
Program Director
Self

Patient Care

Patient survey

Faculty Member
Patient/Family Member

Patient Care

Record/chart view

Faculty Member
Program Director

Patient Care

Review of case or procedure log

Program Director


Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and behavioral knowledge needed by a Pediatric Endocrinologist; demonstrate ability to acquire, critically interpret and apply this knowledge in patient care.

Principal Educational Objectives

Learning Activities

Describe findings of common endocrine disorders

Attend courses; attend clinical conference and rounds.
Assigned reading

Describe the evaluation of a patient with a potential endocrine emergency

Attend courses; attend clinical conference and rounds.
Assigned reading

Explain findings on clinical history and exam that suggest a known or potential endocrine disorder

Direct patient care, rounds, assigned reading


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Medical Knowledge

Global assessment

Faculty Member
Program Director
Self

Medical Knowledge

In-training Examination

Faculty Member
Program Director

Medical Knowledge

Multisource assessment

Faculty Member
Program Director
Self


Competency 3: Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

Principal Educational Objectives

Learning Activities

Participate in genetic counseling sessions for endocrine disorders

Direct patient care; faculty supervision;

Write letters to patients/families which discuss sensitive issues related to the condition

Direct patient care; faculty supervision;

Communicate effectively with physicians, other team staff
to create and sustain information exchange for patient care; maintain accurate records which are timely

Direct patient care; attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Interpersonal & Communication Skills

Global assessment

Faculty Member
Program Director
Self

Interpersonal & Communication Skills

Multisource assessment

Faculty Member
Program Director
Self


Competency 4: Practice-Based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

Principal Educational Objectives

Learning Activities

Develop strategies to learn about future advances in the understanding of endocrine disorders in order to incorporate into one’s practice improved screening, identification, counseling and management of these disorders

Journal Club, attend rounds and clinical conferences,

Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing education conferences

Journal club, attend rounds and clinical conferences


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Practice-based Learning & Improvement

Global assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Multisource assessment

Faculty Member
Program Director
Self

Practice-based Learning & Improvement

Record/chart view

Faculty Member
Program Director


Competency 5: Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity

Principal Educational Objectives

Learning Activities

Discuss the ethical, legal, financial and social issues of diagnosis/testing in children that may present in adulthood,
providing medical care for patients with known disorders

Direct patient care, journal club, attending rounds and clinical conferences

Demonstrate a commitment and personal accountability to the well being of all patients, your own and consults, and follow--up on lab results, writing comprehensive notes

Attend rounds, clinical conference


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Professionalism

Global assessment

Faculty Member
Program Director
Self

Professionalism

Multisource assessment

Faculty Member
Program Director
Self

Professionalism

Patient Survey

Patient/family member


Competency 6: Systems-Based Practice

Understand how to practice quality health care and advocate for patients within the context of the health care system.

 

Principal Educational Objectives

Learning Activities

Identify written and internet resources
to aid in endocrine diagnoses to supplement physical findings and lab results

Direct patient care, faculty supervision

Recognize and advocate for patients who need assistance to deal with burdens of disease and care

Direct patient care, faculty supervision


Evaluation Methods

Competency

Assessment method

Evaluator(s)

Systems-based practice

Global assessment

Faculty Member
Program Director
Self

Systems-based practice

Patient survey

Patient/family member

Systems-based practice

Record/chart view

Faculty Member
Program Director


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Clinical Training Rotations

A typical training schedule for first-year fellows includes the following rotations:

Rotation

Duration

Program Director

Johns Hopkins University Hospital

1 months

David Cooke, MD

Georgetown University

1 months

Kristen B. Hawkins, MD, MPH & Douglas Sobel, MD

NIH Clinical Research Center (CRC)

6 months

Maya Lodish, MD, MHSc, FAAP (director)

Children’s National Medical Center

4 months

Priya Vaidyanathan, MD

During the second and third years, mandatory clinical responsibilities are limited to a half-day continuity clinic per week and providing inpatient pediatric endocrine consultation on an on-call basis.


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Didactic Training

Regularly scheduled didactic courses, seminars, and case conferences enhance clinical experience. These include the following weekly events:

  • Inter-Institute Endocrine Grand Rounds
  • Pediatric Endocrine Case Conference
  • Pediatric Endocrine post-clinic conference
  • Lecture series covering both clinical and research topics
  • Journal Club (once a month)
  • Board review (weekly)

Fellows are encouraged to attend at least one national/ international professional meeting/year during the three fellowship years.


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Research Training

Fellows learn how to develop a research protocol, conduct a study, evaluate the results, and create a presentation or a manuscript suitable for publication. Work in a laboratory setting performing state-of-the-art basic science research is closely supervised by internationally known mentors. During the first year, a research mentor is chosen and the project for each fellow and progress on it are monitored by a committee, as recommended by the American Board of Pediatrics (see http://www.abp.org).  With the mentor’s help, a topic of special interest is defined and a research protocol is developed. The second and third years of the fellowship are dedicated to the successful completion of the selected project(s) with minimal clinical duty requirements. See also the following site for more information on research training at the NIH:

NIH Office of Intramural Training and Education: http://www.training.nih.gov


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Call Frequency

There is no in-house call. During the first year, pediatric endocrine fellows are on call from home approximately 1 week every 4-6 weeks depending on rotation (CNHS vs NIH respectively), supported by one of the endocrine attendings. During the second and third years, fellows take call from home when they participate in the NIH pediatric endocrine consult service (8-12 weeks of the year) and CNMC inpatient servcie (3-4 weeks per year total).


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Teaching Opportunities

Third-year fellows are required to take a supervisory role and cover the pediatric endocrine inpatient service at the NIH-CC for one month. During these 4 weeks, the senior fellow supervises first-year fellows, residents, and students and is responsible for teaching rounds and conferences.


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Evaluation and Quality Assurance

The fellow meets with the program director, the mentor, and the supervising committee on a regular basis to assess personal goals and objectives, and to review evaluations from the staff. All fellows and other staff participate in regular staff meetings, and quality assurance is monitored both at the program and at the hospital level by regular (weekly and other) meetings.


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Application Information/Eligibility Criteria

The Pediatric Endocrinology Program is fully accredited by the Accreditation Council for Graduate Medical Education. Applications are submitted through ERAS, ERAS fellowship application site. Our program participates in the NRMP match (NRMP site)  Upon successful completion of the three-year training program, fellows are eligible to sit for the examination of the American Board of Pediatrics. Qualified candidates must have completed PGY-3 level training prior to initiation of the fellowship, and should be eligible for board certification by the American Board of Pediatrics. There are up to three positions available per year. Fellows stay a minimum of three years; selected fellows can stay additional years as senior medical staff fellows, or through other mechanisms. For further information applicants should contact:

Constantine Stratakis, MD D(med)Sci
Scientific Director, NICHD

Miranda M Broadney, MD, MPH
Acting Program Director, Pediatric Endocrinology Training Program, NICHD

Ms. Fetima (Worthington) Benjamin
Program Coordinator, Pediatric Endocrinology Training Program, NICHD

  • Tel: 301-451-1466
  • Fax: 301-480-0378

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