Training
Paediatric Endocrinology is part of the General Specialist Training
syllabus and this is detailed in the RCPCH Handbook on General
Specialist Training (Summary in Appendix
2).
The principles of Higher Specialist Training can be broken down
into clinical paediatric training and multi-disciplinary training
and a more detailed syllabus with a break down of subjects into
the Foundation and Advanced Course components is provided in Appendix
3.
A). Clinical PaediatricTraining
This should involve the following:
i) Background
A thorough modern grounding in the normal physiology of the endocrine
system
including the physiology and biochemistry of hormones and their
actions.
Embryology of the endocrine system including that of the reproductive
organs
coupled with extensive knowledge of the pathophysiology of disorders
of the
genital tract are required.
Physiology and pathophysiology of growth along with knowledge
of the principles
and practice of anthropometric assessment.
ii) Endocrinology
Extensive first hand practical experience in a recognised training
centre of the
management of diseases primarily involving the endocrine system.
These should
include disorders of the following:-
- the thyroid gland
- the neuroendocrine system (hypothalamus and pituitary)
- the adrenal glands
- endocrine function of the gonads
- the endocrine system in growth and development
- hormonal control of blood pressure.
In particular a detailed knowledge of clinical laboratory and
genetic management of
adrenal disorders particularly adrenal hyperplasia and disorders
of sexual differentiation
are essential.
iii) Diabetes
Extensive practical experience in all aspects of diabetes mellitus
and its
complications. This includes:-
- management of acute problems particularly diabetic ketoacidosis,
cerebral oedema and hypoglycaemia
- diabetes monitoring and evaluation of control
- diabetes education
- evaluation of retinal, neurological, vascular and kidney
complications
- psychological aspects of chronic illness
- community aspects of diabetic care (team management, clinic
care)
- diabetes associated with other chronic illnesses eg. cystic
fibrosis
- type II diabetes
iv) Metabolic disease
Extensive first hand practical experience in a range of metabolic
and nutritional
disorders including the following:-
- hypoglycaemia disorders
- metabolic bone disease and calcium disorders
- lipid disorders
- obesity
- fluid and electrolyte disorders
v) Laboratory endocrinology
An understanding of the principles and practice of hormone assay
methods and the
use of diagnostic tests is essential. Training should include
practical experience in
an endocrine laboratory and the endocrinologist should have access
to an up-to-date
hormone assay service which should participate in national quality
control
schemes.
An understanding of the principles and practice of cellular and/or
molecular
biology techniques particularly with respect to endocrine disorders.
Practical
experience is desirable but not essential.
The laboratory work experience may be obtained as part of a research
post.
B) Multidisciplinary
Training
i) Clinical
This is particularly important in the following areas:-
- liaison with adult endocrinologists is essential and could
be provided within the setting of joint adolescent clinics
- liaison with other paediatric subspecialties particularly
those in which endocrine complications of the disease process
are important eg. post oncology therapy and renal disease
- surgical endocrinology: involvement in pre- and post-operative
management of pituitary disease, diabetes and thyroid disease
- access to and experience with imaging facilities for endocrine
disease such as radioisotopes, ultrasonography and magnetic
resonance imaging.
- involvement with a multidisciplinary team in the management
of disorders of sexual differentiation eg. gynaecologists, urologists,
molecular biologists and biochemists.
ii) Biostatistics
Background knowledge of statistical and epidemiological principles
should be
included in training programmes to allow for critical appraisal
of publications, reviews
and audit programmes.
iii) Audit
Exposure to and practical involvement in clinical audit should
be considered as an
integral part of all training programmes
iv) Personal Development
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