APDEM Meeting May 27, 2016 AACE 25th Annual Scientific and Clinical - - PDF document
6/7/2016 APDEM Meeting May 27, 2016 AACE 25th Annual Scientific and Clinical Congress Our Time Today APDEM Business Report APDEM Initiatives Endocrinology and NRMPs All In Policy Tools to Support Fellowship Training
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May 27, 2016 AACE 25th Annual Scientific and Clinical Congress
Our Time Today
APDEM Business Report APDEM Initiatives
Endocrinology and NRMP’s “All‐In” Policy Tools to Support Fellowship Training
APDEM Fellowship curriculum Fellow Training Series in partnership with Endocrine society ACCE/APDEM committee
Open Discussion
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APDEM Business Report
Treasurer Report Membership Report
Total membership = 92 Target membership = 136 ACGME programs
Potential change to APDEM Membership Bylaws
Potential Change to APDEM Bylaws: Membership
Currently: membership restricted to division directors
and training program directors
Proposed: program‐based membership to APDEM
Multiple contacts on record: program director, associate
program directors and program coordinators
PD: primary contact and voting member for the program Better tracking and support for training programs
Email your feedback to apdem@endocrine.org Approval process – spring/summer 2016
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Current NRMP policy vs. All In
Current
Match participation by at least 75% of eligible programs At least 75% of all available positions secured through the
Match
All In
Any program registering for the Match must attempt to fill
all positions through the Match
Specific exemptions can be stipulated
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no answer
2015 FELLOW SURVEY: Were you offered a position before Match Day? 30% of this group said they felt pressure to accept the out‐of‐ Match offer 2015 FELLOW SURVEY: Would you prefer having 100% of endocrine programs participate in the Match? 78% of respondents
no answer
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APDEM All‐In Match Working Group
Convened by Council November 2015 Explore potential desirability of an All‐In Match Policy for
endocrinology
Members:
Christopher McCartney, MD (Chair) Andrew Gianoukakis, MD Geetha Gopalakrishnan, MD Janet McGill, MD Paris Roach, MD Elias Said Siraj, MD Mark True, MD
Work of the group
Identify and explore available options (benefits and liabilities) Goal 1. Identify goals/preferences of fellows Goal 2. Identify goals/preferences of PDs/Programs Goal 3. Identify challenges in current system and in an All In
system
Goal 4. Identify potential solutions to identified challenges Goal 5. Develop action plans for success Summary of the Working Group’s deliberations to date (p. 62)
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Selected perspectives
Candidates Out‐of‐Match offers may result in unwanted pressure to make early
commitments
Out‐of‐Match agreements may be best in some situations, e.g.,: Combined training programs, ABIM Research Pathway Military personnel Candidates with an exclusive preference for a given Program Programs Out‐of‐Match offers may be leveraged as a competitive advantage Other Programs (and possibly candidates) may bear opportunity
costs
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APDEM’s Fellowship Curriculum
Revision underway
Aligned with ABIM Exam Blueprint Uniform organization and structure
All topical areas of endocrine training
Clinical topics Other ACGME Competencies
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Overview of Topics and Editors
Adrenal Disorders ‐ Ann Danoff Bone and Mineral Metabolism ‐ Pam Taxel Gonadal Disorders ‐ Chris McCartney Diabetes ‐ Sanjay N. Mediwala Nutrition and Obesity ‐ Daniel Bessesen Lipids ‐ Geetha Gopalakrishnan Pituitary ‐ Elias Said Siraj Thyroid ‐ Whitney Goldner
T
Fundamental Advanced GLUCOCORTICOIDS Cushing Syndrome Clinical Presentation Summarize the symptoms and signs of Cushing syndrome resulting from chronic exposure to excess glucocorticoid, including progressive obesity, dermatologic manifestations, menstrual irregularities, signs of adrenal androgen excess, proximal muscle wasting and weakness, bone loss, glucose intolerance, cardiovascular disease, thromboembolic events, neuropsychological changes and impaired cognition, and infection and impaired immune function. Differential Diagnosis (Adrenal vs Ectopic vs Pituitary vs Exogenous vs Physiologic) Perform the differential diagnosis of Cushing syndrome to determine the source of cortisol excess, which could be adrenal, ectopic, or pituitary. Diagnostic Tests Select and interpret results from appropriate case-detection (screening) tests, which may include measurement of 24-hour urinary cortisol excretion, late-night salivary or serum cortisol measurement, or 1-mg
Select and interpret results from appropriate diagnostic tests to determine the source of glucocorticoid excess, which may include measurement of corticotropin inferior petrosal sinus sampling diurnal serum cortisol
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GLUCOCORTICOIDS Cushing Syndrome: Diagnosis *Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(5):1526-1540. Clinical Practice Guideline *Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing's syndrome. Lancet. 2015:386(9996):913-927. Article Beuschlein F, Fassnacht M, Assié G, et al. Constitutive activation of PKA catalytic subunit in adrenal Cushing’s syndrome. N Engl J Med. 2014;370(11):1019-1028. Article Kirschner LS. Medicine. A unified cause for adrenal Cushing’s syndrome. Science. 2014;344(6186):804-805. Article Assié G, Libé R, Espiard S, et al. ARMC5 mutations in macronodular adrenal hyperplasia with Cushing’s syndrome. N Engl J Med. 2013;369(22):2105-2114. Article Lacroix A. Heredity and cortisol regulation in bilateral macronodular adrenal
Article Louiset E, Duparc C, Young J, et al. Intraadrenal corticotropin in bilateral macronodular adrenal hyperplasia. N Engl J Med. 2013;369(22):2115-2125. Article Anselmo J, Medeiros S, Carneiro V, et al. A large family with Carney complex caused by the S147G PRKAR1A mutation shows a unique spectrum of disease including adrenocortical cancer. J Clin Endocrinol Metab. 2012;97(2):351-359. Article Almeida MQ, Harran M, Bimpaki EI, et al. Integrated genomic analysis of nodular Article
Foundational Utility of Curriculum
Topics to expand to include other ACGME Core
Competencies (e.g., Professionalism)
Linking to NAS Milestones Ability for community to organize efforts Development of targeted education Building out curriculum for medical school and
residency
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ENDOCRINE SOCIETY
Procedural Assessment Tools
Endocrine Society
– Interpretation of thyroid ultrasonography – Management of insulin pumps and continuous glucose monitoring (CGM) – Interpretation of dual-energy X-ray absorptiometry (DXA)
feedback
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Interpretation of thyroid ultrasonography Management of insulin pumps and continuous glucose monitoring (CGM)
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Interpretation of dual-energy X-ray absorptiometry (DXA) Overview of project
Education Committee (CEEC)
training programs (PDs, fellows)
Society Center for Learning (education.endocrine.org)
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Members
Ann Danoff, MD ‐ Philadelphia, PA Kathleen Figaro, MD, MS ‐ Davenport, IA Geetha Gopalakrishnan, MD – East Providence, RI Ved Gossain, MD, FRCP, FACE ‐ East Lansing, MI Jonathan Leffert, MD, FACP, FACE, ECNU ‐ Dallas, TX David Lieb, MD, FACE ‐ Norfolk, VA Sara Lubitz, MD ‐ Westfield, NJ Janet McGill, MD, FACE ‐ Saint Louis, MO Vin Tangpricha, MD, PhD, FACE ‐ Atlanta, GA Dace Trence, MD, FACE ‐ Bellevue – WA
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Committee Charges
1.
Pursue ways in in which APDEM and AACE may collaborate on enhancing the educational curriculum and experience for fellows‐in‐training that will best serve to prepare them for pursuing their chosen area of interest and practice environment upon completion of their training.
2.
Partner together in the development of teaching materials for fellows and reviewing the curriculum to ensure that it meets the needs of the current and changing practice environment.
3.
Explore ways to encourage more interest in endocrine fellowships to address the severe shortage of endocrinologist workforce.
Potential Areas
1.
Business of Endocrinology (how to decide what type of job you want, negotiation, contracts, budgets, etc.)
2.
Developing a series on common problems encountered in an endocrine practice (the non‐zebras: normal TSH, convinced fatigue is related to thyroid diathiasis; adrenal fatigue; eating disorders; non‐endocrine hair loss; normal T, wanting T, etc.)
3.
Working on a team in the office
4.
Developing a mentoring system/pool
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