Appendix
3 - Syllabus for higher specialist training in endocrinology and
diabetes
This information supplements the information
outlined in the RCPCH Syllabus and Training recor
The components of the two courses are denoted by
(2) Secondary and (3) Tertiary. All expected to cover sections
A, C, E, F, H, I and J. As Endocrinology and Diabetes are predominantly
Outpatient Specialities it is not possible to state precise times
to be spent in each module. Competence rather than time spent
in a module/teaching area is desired. As a result Training Centres/Modules
are defined on patient numbers seen at the centre as well as the
case-mix. The trainee should keep a written record of patients
seen by themselves, proceedures conducted, diagnosis and therapeutic
interventions instigated and followed-up.
A. FOUNDATION
STUDIES IN ENDOCRINOLOGY (2 & 3)
Basic knowledge
- general principles of molecular biology. Specific reference
to the molecular regulation of
the GH gene and steroid hormone action at the molecular level
- secondary messenger signalling systems used in the endocrine
system
- neuroendocrinology of the anterior and posterior pituitary
hormones and their action
- transport, biochemical actions and control of hormone secretion
- steroid biosynthetic pathways
- embryology of the endocrine system
- embryology of the genital tract and molecular basis for
sexual differentiation
- principles of growth assessment
Skills
- ability to conduct an anthropometric assessment
- assessment of skeletal maturation staging of pubertal development.
Resources
- endocrine clinics
- liaison with basic scientists
- sessions dedicated to basic science issues
- structured in-house, BSPED approved, endocrine teaching
cours
- postgraduate courses of the Society for Endocrinology/Royal
College of Physicians/British Diabetic Association/European
Society for Paediatric Endocrinology/BSPED Regional CME Meetings
- annual meetings of the British Endocrine Societies, the
Society for Endocrinology,European Society for Paediatric
Endocrinology and British Society for Paediatric Endocrinology
and Diabetes
Evaluation
- clinical progress
- course attendance
- supervision of anthropometric techniques
- membership of learned endocrine societies, Society for Endocrinology,
Endocrine Society (USA), European Society for Paediatric Endocrinology,
British Society for Paediatric Endocrinology and Diabetes.
Literature
- clinical and basic science reviews in Journal of Clinical
Endocrinology and Metabolism,
Endocrinology, Endocrine Reviews, Clinical Endocrinology and
Journal of Endocrinology
- Williams Textbook of Endocrinology. (8th Ed).
- Brook CGD. Clinical Paediatric Endocrinology. (3rd Ed) Blackwell
Scientific Publications, Oxford, 1995.
- Brook CGD. A guide to the practice of Paediatric Endocrinology.
Cambridge University Press, Cambridge, 1993.
- De Groot LJ. Endocrinology. (3rd Ed). Saunders, Philadelphia,
1995.
- Wilkins. The diagnosis and treatment of endocrine disorders
in childhood and adolescence. Thomas, 4th Edition.
- Lifshitz. Pediatric Endocrinology. Dekker, 3rd edition.
- Wales, Wit & Rogol. Atlas of Pediatric Endocrinology
& Growth. Mosby 1996
B.
PRINCIPLES AND PRACTICE OF ENDOCRINOLOGY.
Basic knowledge
- recognise, initiate diagnostic tests and outline management
and referral criteria (2) of:-
- - hypo (2) and hyperthyroidism
- - neuroendocrine system eg. Cushing's disease (3)
- - adrenal hyper and hypo states including congenital adrenal
hyperplasia (3)
- - early and late sexual development (2)
- - ambiguous genitalia (3)
- - short stature, growth delay, excessive growth, (2)
- - hypoglycaemia (2)
- evaluate biochemical, radiological and other tests used
in endocrine practice (2)
- pharmacology of (commonly used (2) ) therapeutic agents
(3)
- management of endocrine problems in adolescence (3)
Skills
- administer and interpret investigations for endocrine disorders
(2)
- competence in understanding pharmacokinetics/dynamics of
therapeutic agents used (2)
- development of effective communication strategies (2)
Resources
- distance based learning
- local endocrinology protocols and clinical service guidelines
- courses on communication techniques
Evaluation
- attendance at clinics. Personal involvement in management
of conditions.
- individual case discussion
- real data interpretation
Literature
- Brook CGD. 1995 Clinical Paediatric Endocrinology. (3rd
Ed.). Blackwell Scientific Publications, Oxford.
- Lifschitz F. Paediatric Endocrinology. (3rd Ed). Marcel
Dekker, New York, 1997.
- Williams Textbook of Endocrinology. (8th Ed).
- Wilkins. The diagnosis and treatment of endocrine disorders
in childhood and adolescence. Thomas, 4th Edition.
C. DIABETES (2 & 3)
Basic knowledge
- epidemiology and aetiology of IDDM
- presentation of IDDM in infancy, childhood and adolescence
- management of diabetic ketoacidosis, hyperglycaemia, hypoglycaemia
- cerebral oedema management
- pharmacology of insulin
- complications of diabetes
- diabetes associated with other diseases
- predictors of IDDM and intervention studies
- management of IDDM in adolescence
- obesity and NIDDM. Concept of insulin resistance
Skills
- acute management of IDDM, role of ITU
- injection and monitoring skills
- develop teamwork approach to diabetic care, dietician, nurse
specialists, psychologist
- Principles of basic dietary education; The adaption of
diet to insulin profiles and exercize.
- develop concept of diabetic in the family and community
- administer and/or interpret tests to detect diabetic complications
- laboratory experience of glycated protein analysis
Resources
- register of diabetic patients
- dedicated paediatric diabetic clinic
- team approach to diabetic care. Act as observer and team
member on
consultations/follow-up. Participation in diabetes camps/holidays.
- laboratory liaison
- sessions with adult diabetologists/nephrologists/opthalmologists
Evaluation
- clinic attendance monitoring and follow-up of diabetic children
- tracking of changes in markers of control with respect to
intervention
- research opportunities
Literature
- Pickup JC, Williams G. Textbook of diabetes. Blackwell Scientific
Publication, Oxford,
- Kelnar CJ. Textbook of childhood and adolescent diabetes.
Chapman Hall, London.
- Court & Lamb. Textbook of childhood and adolescent diabetes.
Wiley, 1997.
- Alberti et al. International Textbook of Diabetes Mellitus.
Wiley, 1997.
D. METABOLIC DISEASE
Basic knowledge
- metabolic bone disease and calcium disorders (3)
- lipid biochemistry, lipid disorders, genetic diagnosis and
clinical management (3)
- polyuria/polydipsia. Investigation of differential diagnosis.
(3)
- diagnosis and management of hypoglycaemia (2)
Skills
- ability to administer and interpret investigations (2)
Resources
- single or multiple endocrine centres may be required to
cover this area in depth
- liaison with adult lipidologist/diabetologist
Evaluation
- attendance at clinics and personal involvement
- individual case discussion
- real data interpretation
Literature
- Williams Textbook of Endocrinology. (8th Ed).
- Brook CGD. 1995 Clinical Paediatric Endocrinology. (3rd
Ed). Blackwell Scientific Publications, Oxford.
- Wilkins. The diagnosis and treatment of endocrine disorders
in childhood and adolescence. Thomas, 4th Edition.
- Lifshitz. Pediatric Endocrinology. Dekker, 3rd edition.
- Becker. Principles & Practice of Endocrinology &
Metabolism. Lippincott, 1990.
E. LABORATORY ENDOCRINOLOGY
Basic knowledge
- principles of good laboratory practice (2)
- principles of radioimmunoassay and newer technologies eg.
ELISA, chemluminescence (3)
- difference between immuno and bioassays (3)
- steroid hormone analysis by chromatography and mass spectroscopy
(3)
- assessment of assay performance and quality control (3)
- principles of molecular biology (3)
- - analysis of DNA and RNA
- - role of PCR
- - semi quantitative assessment
- importance of sample collection (3)
- limitations of commonly used endocrine tests (2)
Skills
- perform an immunoassay (3)
Resources
- time spent in endocrine laboratory
- time spent attached to molecular biology group
- Society for Endocrinology molecular biology courses
Evaluation
- completion of laboratory work to satisfaction of laboratory
manager
- regular review of laboratory methodology as applied to clinical
practice
Literature
- Edwards, R. Immunoassay. An introduction. William Heineman
Medical, London, 1985
- Thakker R (ed). Genetic and molecular biological aspects
of endocrine disease. Balliere.
- Strike, PW. Medical Laboratory Statistics. John Wright &
Sons Ltd, Bristol, 1981
F. MULTIDISCIPLINARY
TRAINING (2 & 3).
Basic knowledge
- the role of joint adolescent clinics in providing endocrine/diabetes
needs for young adults
- transferring to adult endocrine/diabetes practice
- adolescent perspectives of chronic illness
- implications of childhood endocrine disease for Adult Endocrinology
- - oncology and radiotherapy
- - renal disease
- - respiratory disease
- the role of surgery in managing endocrine disease
- application of imaging techniques to endocrine evaluation
- psychological implications of endocrine disease. Psychosocial
impact on endocrine disease.
Skills
- managing multidisciplinary teams
Evaluation
- attendance at Adult Endocrinology clinics (formal involvement
for 6 months)
- attendance at joint paediatric subspecialty clinics for
the long term follow-up of complex endocrine problems
- visit to hospital imaging services. Liaison with imaging
practitioners.
Literature
- Becker. Principles & Practice of Endocrinology &
Metabolism. Lippincott, 1990.
- Brook CGD. 1995 Clinical Paediatric Endocrinology. (3rd
Ed.). Blackwell Scientific
Publications, Oxford.
- Wilkins. The diagnosis and treatment of endocrine disorders
in childhood and adolescence. Thomas, 4th Edition.
- Lifshitz. Pediatric Endocrinology. Dekker, 3rd edition.
- Alberti et al. International Textbook of Diabetes Mellitus.
Wiley, 1997.
- Hofmann A. Adolescent Medicine. Addison Wesley, California,
1983
G. BIOSTATISTICS
Basic knowledge
- application of parametric and nonparametric statistics (3)
- statistical modelling (3)
- method comparison studies (3)
- principles of screening and surveillance programmes (2)
- study design (3)
- principles of health economics
- evidence based endocrinology (2)
- critical appraisal of literature (2)
- principles of systematic reviews (3)
- place of information technology in clinical and research
practice (2)
Resources
- university statistics clinic
- sessions with Health Services Research personnel
- local IT network
Evaluation
- critical appraisal of literature
- worked examples
- trial design
- construction of scientific paper/presentation
Literature
- statistical/health service reviews in New England Journal
of Medicine, Lancet, British Medical Journal, Evidence Based
Medicine
- Altman DG. Practical statistics for medical research. Chapman
and Hall, London, 1991.
- Bailar JC, Mostellar F. Medical uses of statistics. (2nd
Ed) New England Journal of
Medicine Books, Boston, 1992
H. AUDIT (2 & 3).
Basic knowledge
- the audit cycle
- identification and conduct of audit studies
- promoting change
Resources
- disease registers
- hospital audit departments
Evaluation
- example(s) of audit process in action
Literature
- reviews and reports in general medical journals
I. MANAGEMENT (2 & 3).
This generic syllabus has been prepared for the Academy of
Royal Colleges to describe the management skills and knowledge
needed by all practising doctors. There are 5 groups of capabilities.
Contextual awareness - understanding and ability to operate
effectively at all appropriate levels in the context of the
NHS structure. Knowledge of the following is important:-
- Political and economic context - making difficult choices.
- Central government public health and health service strategies
NHS funding
- Roles of major constituents of NHS and of other relevant
agencies, e.g. social services
- Senior organisational roles
- Structure and process of local units
- Understanding the societal forces shaping the demand for
health services.
Strategic thinking - understanding of strategic processes
and ability to apply them:-
- Generating a vision and long term strategies
- Contributing to the development of organisational goals
- Linking day-to-day activities and strategic plans
Functional/operational skills and knowledge- skills in a wide
range of activities and processes associated with the day-to-day
operation of units in health care organisations. These include:-
- Implementing clinical guidelines
- Accessing information
- Making effective use of resources
- Handling complaints
- Recruitment
- Appraisal techniques
- Disciplinary procedures.
Interpersonal/team skills -ability to relate effectively with
colleagues, line managers, staff and others associated with
the organisation. This may involve:-
- Professional leadership
- Influencing others
- Using political skills
- Communicating sensitive information
- Counselling colleagues and subordinates, mentoring
- Contribution to meetings
- Making presentations
- Delegating work to colleagues
- Developing team spirit
Self management skills -skills used in professional and personal
development. These include:-
- Learning effectively from experience
- Receiving direction from others
- Implementing difficult non-clinical decisions
- Acting independently/using initiative
- Time management
- Writing reports
- Adopting ethical management stance
- Handling uncertainty
- Self-awareness
- Effective presentation of self.
Literature
- regular review articles in British Medical Journal/Lancet/New
England Journal of
Medicine
J. EDUCATION (2 & 3)
Basic Knowledge
- defining aims of teaching course/programme/lecture
- targeting different audiences
- preparation of teaching material
Resources
- BSPED distance based learning
Evaluation
- presentation of lectures to different audiences
- bedside teaching programmes
- educational material developed
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