General aspects of training in paediatric endocrinology
1. General
Only a medical doctor who has successfully completed his/her
training of at least 2 years in the common trunk of paediatrics
(General Specialist Training) will be eligible for access to further
specialist training in Paediatric Endocrinology. Progression in
the United Kingdom will depend on the possession of the MRCP or
its future equivalent.
The CSAC will be responsible for providing career advice
at an early stage of Higher Specialist Training (HST), and toward
the end of the 2nd Core Year of HST award and record centrally
an Endocrine Training Number. The CSAC will be responsible with
Local Course Organisers, Regional Advisers and Deans for assessing
the progress of the trainee in secondary training and their suitability
for tertiary training in the light of their skills and aspirations
but also taking into account manpower needs of the speciality.
Retraining will be offered through local mechanisms where career
aspirations change, progress is deemed to be unsatisfactory or
if dictated by manpower considerations.
2.
Secondary Course in Paediatric Endocrinology and Diabetes
The aim of the Secondary course in Paediatric Endocrinology and Diabetes
training would be to provide training to allow competent practice to be
undertaken as a Paediatrician with a Special Interest. It is likely that
such an individual would be expected to provide care for:-
- the district diabetic population
- children with primary hypothyroidism
- individuals with delayed puberty
- growth hormone deficient children (possibly)
- short and tall stature children
and as such it would be expected that such an individual would have covered
at least 4 out of these 5 areas. More complex endocrine problems could
be cared for locally but only in the context of a joint Consultative Clinic
held with a Paediatric Endocrinologist. This concept of a joint working
partnership is central to this proposal. This could take the form of outreach
clinics held jointly and/or the Paediatrician with an Interest working
with the Specialist in Paediatric Endocrinology at their Endocrine Centre.
Entry would take place after the Common Trunk and after 2 years
of the General Paediatric component of Higher Specialist Training.
(See flow chart)
One to two years would then be spent in Paediatric Endocrinology
and Diabetes. It should be possible also with this type of training
to gain training in Diabetes only. There is currently
no EC recognition of speciality interests, and a CCST will only
be issued in Paediatrics, however it is likely that the RCPCH
will allow the Endocrine CSAC to certify attainment of this standard
in some informal manner.
3.
Tertiary Course in Paediatric Endocrinology and Diabetes
The aim of the Tertiary course in Paediatric Endocrinology and Diabetes
training would be to provide training to allow competent practice to be
undertaken as a Specialist in Paediatric Endocrinology and Diabetes whose
practice would be expected to deal with complex endocrinology:-
- disorders of the adrenal gland
- ambiguous genitalia
- disorders of the anterior and posterior pituitary gland excluding isolated
growth hormone deficiency
- hyperthyroidism
- complications of diabetes
- early puberty
- hypoglycaemia
- disorders of calcium metabolism
- liaison with adult and paediatric colleagues re complex cases eg. post
oncology
and as such it would be expected that in addition to the Secondary Course
the Specialist would have covered at least 7 of these 9 areas. Entry would
take place after the Common Trunk and after 2 years of the General Paediatric
component of Higher Specialist Training. These 2 years in Higher Specialist
Training should be spent ideally as 1 year in General & Community Paediatrics
and neonatology and a second year in part of General Paediatrics relevant
to the training in endocrinology. They would then complete a 3 year dedicated
programme in Paediatric Endocrinology. This programme need not be as segregated
as this, rather an integrated approach could be taken which will include
an excellent exposure to clinical Paediatric Endocrinology, time to develop
a research interest (continue one) with periods of time dedicated towards
laboratory experience/adult liaison.
Time spent in Research should be viewed as essential for a Specialist
in Endocrinology and Diabetes with a minimum period of 1 year to be spent
in Research and ideally 2-3 years. A higher degree (MD or
PhD) is desirable.
There is currently no EC recognition of speciality interests, and a
CCST will only be issued in Paediatrics, however it is likely that the
RCPCH will allow the Endocrine CSAC to certify attainment of this standard
in a non-statutory mannerand EC accreditation with a CCST in Paediatric
Endocrinology is likely in the future.
4. Flexibility
and Continuing Medical Education.
There is a need to maintain flexibility. This will allow those who are
undecided to pursue Higher Specialist Training in General Paediatrics and
then change across to specialty training if they wish and also allow those
who embarked on specialist training to go to be a generalist if specialist
practice is not for them.
Further it is clear that individuals within each of the two groups may
wish to develop personal skills in certain areas. It is clear that different
levels of clinical responsibility are expected from the two groups although
it is clear that this is based on the experience gained as trainees. It
is envisaged that by employing a modular approach to the Endocrinology
and Diabetes training that a persons accreditation might be modified with
time if they underwent subsequent modular training in certain components
of the advanced course eg. disorders of the adrenal gland.
5. Research Training.
Apart from a suggested year of clinical research there is no active
programme at present for prosecution of a research programme. It is unclear
when this should be conducted but suggestions now centre on attainment
of a MD/PhD by prosecuting 3 years of research between the general and
higher specialist training programmes. Where Lecturer appointments are
available for a 4 year period this time should be devoted largely to research
with a clinical/research ratio of 1:3.
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