Education and Training

Centre Accreditation

Identification of, and Recognition as, a European Training Centre In Paediatric Endocrinology and/or Diabetes

Background

On the 20th March 1999 Paediatric Endocrinology and Diabetes was recognised as a subsection of Paediatrics with its own Training Programme by the Union of European Medical Specialists (UEMS). It is the wish of the European Board of Paediatrics that we now identify Training Centres, Chiefs of Training, Tutors and Teachers in order to fulfil the requirements for the provision of training in our subspeciality. The Society will act as the agent of the European Board in this respect and will create a special Committee to do this - the Education and Training Speciality Advisory Committee (ETSAC). Ultimately the recognition of training institutions will be the remit of ETSAC for Endocrinology and Diabetes but at present National Bodies will administer the system. As a first step we need to create a database of the names and characteristics of European Training Centres in endocrinology and diabetes which will be held by ESPE. This will allow plans to be developed to organise in a structural manner quality assurance of the recognised centres and ultimately trainee assessment. This approach applies at this stage only to European Union (EU) and European Free Trade Association (EFTA) Member States. Non EU or EFTA States may submit their Training Programmes and Training Centres for assessment if they so wish.

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Criteria

A training centre can be a single institution or a group of related establishments.

Full Training Centre - The centre must provide adequate experience in all fields of endocrinology including emergency care. A full component of the Foundation and Advanced Courses must be provided. The number of activities must be sufficient to provide at least a minimum experience for a trainee. A group of related establishments can be considered a centre and each component considered as a unit contributing one or more modules to either the Foundation or Advanced Course.

The centre must have easy access and close relationships with other relevant specialities such as nuclear medicine, imaging facilities, surgery and laboratory facilities. The centre must provide evidence of ongoing clinical research and access to basic research.

The centre will be responsible for weekly clinical staff/seminar teaching and participation in regional/national meetings.

Basic textbooks in endocrinology/diabetes should be immediately available and there should be easy access to a comprehensive reference library either in paper or electronic format.

Training Unit - Training Units are institutions that provide training in one or more aspects of the Foundation and/or Advanced Courses. They must provide adequate exposure in the defined area and a teacher who is deemed competent in these areas.

Training Staff - the training staff in a Centre should include at least two teachers.

The Chief of Training or Paediatric Endocrine Training Director must have been practising Paediatric Endocrinology for at least 10 years and have specialist accreditation.

There should be additional Paediatric Endocrine Tutors who should provide training in all aspects of the speciality and hold a research tradition in Paediatric Endocrinology. When an aspect of training cannot be provided in one centre it would be necessary for the trainee to be taught elsewhere by a teacher (Paediatric Endocrine Teacher) approved for that purpose. A Teacher is a person who holds acknowledged expertise in one or several aspects of Paediatric Endocrinology. This person's contribution may be restricted to these areas of expertise.

The Chief in conjunction with the Tutors and Teachers should work out a training programme for the trainee in accordance with the trainee's own qualities and the available facilities of the institution. Regular review will be required to allow for flexibility and to allow for early identification of problems/deficiencies.

In order to provide a close personal monitoring of the trainee during his/her training, the number of trainees should not exceed the number of teachers in the centre. A tutor, preferably an external teacher, should be appointed to act as an impartial assessor/mentor for the trainee.

The Chief with the Tutors and Teachers will meet the trainee at the beginning of the programme to define the educational contract for that trainee. Reviews of progress should take place at 3 monthly intervals to appraise the individual. An annual assessment should be undertaken to state competencies achieved and to allow progress within the teaching programme. Assessments should be detailed and contain statements of theoretical and practical experience accumulated by the trainee.

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Quality Control

The assessment instrument will be the periodic visitation of the Training Centre and its Teaching Components by the National Body and ultimately by ESPE ETSAC. The purpose of the visits is improvement, assurance and assessment of the quality of training in the training centre. To achieve this the level of training will be compared with criteria that are adopted by the National Body, the European Board of Paediatrics and the UEMS. The outcome of the visitation will be used in a National and European Certification and Recertification programme. More details of the Visitation process are given in the document "Training in Paediatric Endocrinology and Diabetes in the United Kingdom - Part Three Assessment of Training Institutions available on http://bspe.shef.ac.uk or from the ESPE Secretary.

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Module Provision

See also full syllabus

The provision of Training in Paediatric Endocrinology and Diabetes is based on a modular structure and is outlined in detail in the Document "Training in Paediatric Endocrinology and Diabetes in Europe" and is available from the ESPE Secretary. This document set out the minimum requirements for training in the subspeciality of Paediatric Endocrinology and Diabetes.

The aim of training is to develop two styles of clinical practice depending on the Health Care Structure in the Member State, the General Paediatrician with a Special Interest and the Tertiary Care Specialist. The majority of European States do not have General Paediatricians with a Special Interest but National views need to be accommodated. The training is structured to provide a Foundation course in Paediatric Endocrinology and Diabetes training which would 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.

The Advanced course in Paediatric Endocrinology and Diabetes would provide training to allow competent practice to be undertaken as a Specialist in Paediatric Endocrinology and Diabetes. This individual's 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

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Paperwork

  1. Centre Details (64kb)
    1. Chief of Training
    2. Tutors
    3. Teachers
    4. Centre Components
  2. Trainer CV's (62kb)
  3. Institution Details Endocrinology (66kb)
  4. Institution Details Diabetes (57kb)

Training Modules

These are devised to allow for delivery of the syllabus. Please use the information given below to help construct the Module Provision Form for the Centre and its Training Unit Components.

  1. Foundation or Obligatory Modules
    • Clinical Foundation Studies in Endocrinology
      • Module BK: Basic knowledge of Endocrine Science
        This should include the general principles of molecular biology, transport, biochemical actions and control of hormone secretion and secondary messenger signalling systems, the neuroendocrinology of the anterior and posterior pituitary hormones, steroid biosynthetic pathways and the basic immunology with an emphasis on autoimmunity. A working knowledge of the embryology of the endocrine system and of the genital tract is expected.
      • Module GA: Growth Assessment
        The principles and practice of growth assessment including height, weight and pubertal assessment. Uses of growth charts and quality control of growth measurements.
      • Module GB: Bone Age Assessment
        Assessment of bone age and determination of height prediction. Determination of bone age and height prediction in 50 patients with different growth disorders.
      • Module PM: Patient Management
        Evidence of outpatient and inpatient assessment of the conditions listed below (numbers indicate the minimum number of cases). This includes recognition, institution of diagnostic tests, interpretation and outline management. Creation of clinical management workbook.
      • Module PMT: Hypothyroidism
        Diagnostic procedure and interpretation of 15 cases with hypothyroidism. Where practical (and mandatory in some EU Member States) 20 ultrasound studies of the thyroid.
      • Module PMS: Early and Late Sexual Maturation
        Diagnostic procedure and interpretation of 10 cases with premature sexual maturation and 15 cases of pubertal delay. Evidence of therapeutic intervention and follow-up in 5 cases. Where practical (and mandatory in some EU Member States) 20 ultrasound studies of the uterus and ovaries.
      • Module PMG: Growth Disorders
        Diagnostic procedure and interpretation of 50 cases with significant growth disorders and therapeutic management and monitoring of 15 cases.
      • Module PMH: Hypoglycaemia
        Emergency management and diagnostic investigation.
      • Module CAM: Clinical Audit and Management
        Evidence of audit and management activity as outlined in Syllabus.
      • Module TA: Therapeutic Agents
        Use of therapeutic agents for Module PM with understanding of pharmacokinetics/dynamics of agents used, side effects and potential for drug interactions.
      • Module DM: Diabetes Mellitus
        Presentation of IDDM in infancy, childhood and adolescence and management of diabetic ketoacidosis, hyperglycaemia, hypoglycaemia and cerebral oedema. Knowledge of the pharmacology of insulin. Management of diabetic patients during surgery. Complications of diabetes and diabetes associated with other diseases eg cystic fibrosis and mitochondrial disorders. Management of 40 patients with diabetes mellitus. Sessions with adult diabetologists/nephrologists/opthalmologists
      • Module LE: Laboratory Endocrinology
        Principles of good laboratory practice and the limitations of commonly used endocrine tests.
      • Module MTR: Multi-disciplinary Training
        The role of joint adolescent clinics in providing endocrine/diabetes needs for young adults and transferring to adult endocrine/diabetes practice. Adolescent perspectives of chronic illness. Develop teamwork approach to diabetic care, dietician, nurse specialists, psychologist and the concept of diabetic in the family and community.
    • Academic Foundation in Endocrinology
      • Module BS: Basic Statistics
        Cover appropriate topics in Syllabus section.
      • Module ED: Education
        Self directed learning projects, literature searching, presenting information and consultation practice
  2. Advanced or Desirable Modules
    • Advanced Clinical Studies in Endocrinology
      • Module CE: Complex Endocrinology
      • ModuleCET: Thyroid
        Molecular and immunological mechanisms of thyroid disease. Management of 10 cases with goitre or hyperthyroidism.
      • Module CEN: Neuroendocrine
        Disorders affecting anterior and posterior pituitary function other than idiopathic isolated Growth Hormone problems. Diagnostic procedure and interpretation of 10 cases with hypothalamic-pituitary disorders which must include the management of pituitary dependent Cushing's and post-operative management of craniopharyngioma/pituitary surgery.
      • Module CEA: Adrenal
        Molecular and steroid biochemistry of adrenal disorders. Diagnostic procedure, interpretation and therapy of 10 cases with adrenal disorders.
      • Module CEG: Ambiguous genitalia
        Molecular and biochemical background to disorders of sexual differentiation. Multi-disciplinary approach to the management of the problem. Detailed clinical workbook presentation of at least 4 different types of problem.
      • Module CEC: Calcium Disorders
        Molecular and biochemical background to disorders of calcium metabolism. Diagnostic procedure and interpretation of 5 cases with disorders of bone or calcium/phosphorous metabolism.
      • Module CEM: Endocrine Metabolic Disorders
        Diagnosis and management (medical and surgical) of hypoglycaemia.
      • Module CL: Complex Laboratory Work
        Principles of radioimmunoassay and newer technologies. Steroid hormone analysis by chromatography and mass spectroscopy. Assessment of assay performance and quality control. Principles of molecular biology including analysis of DNA and RNA, role of PCR and semi quantitative assessment. Practical experience in the performance of hormone assays and/or molecular biological techniques.
      • Module MT: Multi-disciplinary Training
      • Module MTA: Adult Endocrinology
        Attendance at Adult Endocrinology clinics (formal involvement for 6 months). Implications of childhood endocrine disease for Adult Endocrinology.
      • Module MTT: Adolescent Transfer
        The role of joint adolescent clinics in providing endocrine/diabetes needs for young adults transferring to adult endocrine/diabetes practice. Participation in this process. Adolescent perspectives of chronic illness
      • Module MTE: Endocrine Complications of other Paediatric Diseases
        Experience of joint clinics/liaison in at least one of the following:
        • oncology and radiotherapy
        • renal disease
        • respiratory disease
      • Module MTS: Surgical Management of Endocrine Disease
        Experience of liaison regarding management of patients with pituitary, thyroid, pancreas and adrenal disorders and the post operative care of these individuals
    • Advanced Academic Studies in Endocrinology
      • Module AS: Advanced Statistics
        See Syllabus Section G.
      • Module RS: Research Activities
        Attendance at local, regional and national Endocrine and Diabetes Meetings and at least 3 International Meetings. Participation in two Audit projects, one systematic style review of a topic and preparation of a detailed evidence based appraisal of a diagnostic test or a therapeutic intervention. Two papers as first author published in International peer reviewed journals.

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Module Provision

Edited for the ESPE website by JKH Wales, September 1999. Layout revised: Sep 2001, May 2005.

This initiative is kindly supported by Abbott Diabetes Care and Roche Diagnostics.

Abbot Diabetes Care        Diagnostics Roche