European Board of Paediatrics The European Training Syllabus in Paediatric Endocrinology and Diabetes Swedish version

Transcription

1 Eurpean Bard f Paediatrics The Eurpean Training Syllabus in Paediatric Endcrinlgy and Diabetes Swedish versin Text in red refers t changes cmpared t the riginal ESPE dcument Preface This training dcument utlines ne f the subspecialist training prgrammes in Tertiary Care Paediatrics, defined by the Eurpean Unin f Medical Specialists (UEMS). This prgramme has been designed by the Eurpean Sciety fr Paediatric Endcrinlgy (ESPE) in cperatin with the Eurpean Bard f Paediatrics. It is apprved by the UEMS sectin f Paediatrics (CESP) and has the supprt f the Endcrinlgy and Diabetes sectin f the UEMS. This text was riginally prduced in Nvember 1995 and submitted t CESP at the Annual Meeting in Graz Subsequent revisins have taken place in January 1997, March 1998 and June First Majr Revisin September 2001 PC Hindmarsh, Chairman ESPE Wrking Grup n Eurpean Training Swedish versin editin: Jan Gustafssn Sten Ivarssn Jhnny Ludvigssn Jhan Svenssn Lars Sävendahl Cntents I. Cmpsitin & Cnstititin f ESPE Wrking Grup II. Intrductin III. Paediatric training in Eurpe IV. General aspects f training in Paediatric Endcrinlgy 1. General Principles 2. Fundatin Curse in Paediatric Endcrinlgy and Diabetes 3. Advanced Curse in Paediatric Endcrinlgy and Diabetes 4. Flexibility and Cntinuing Medical Educatin

2 5. Research Training V. Cntents f Training 1. Cre Training i. Backgrund ii. Endcrinlgy iii. Diabetes iv. Metablic disease v. Labratry endcrinlgy 2. Multidisciplinary Training i. Clinical ii. Bistatistics iii. Audit iv. Persnal Develpment VI. End Result f Training VII. Requirements fr Training Institutins VIII. Requirements fr Teachers in Paediatric Endcrinlgy IX. Requirements f Trainees X. Accreditatin f Centres XI. XII. Delivery f the Training Prgramme 1. Fundatin r Obligatry Mdules 2. Advanced r Desirable Mdules Natinal Training Prgrammes 1. EU Cuntries with Existing Prgrammes 2. EU Cuntries withut Existing Prgrammes 3. Nn-EU Eurpean Cuntries with Existing Prgrammes 4. Nn-EU Eurpean Cuntries withut Existing Prgrammes XIII. APPENDIX 1 Syllabus fr Tertiary Training in Endcrinlgy and Diabetes a. Fundatin Studies b. Principles & Practice c. Diabetes d. Metablic e. Labratry f. Multidisciplinary g. Bistatistics h. Audit i. Management j. Educatin Return t Cntents Educatin and Training Cmmittee Backgrund On the 20th March 1999 the Unin f Eurpean Medical Specialities recgnised Paediatric Endcrinlgy and Diabetes as a subsectin f Paediatrics with its wn Training and Educatin Prgramme. The Eurpean Bard f Paediatrics asked ESPE at the Annual Meeting f the Bard in May 1999 t act as agent fr the Bard in prviding the Training fr Paediatric

3 Endcrinlgy and Diabetes within the Eurpean Unin (EU) Member States and within the States belnging t the Eurpean Free Trade Assciatin (EFTA). T carry ut this functin it is prpsed t create within ESPE an Educatin and Training Advisry Cmmittee (ETAC). Cmpsitin f the Educatin and Training Advisry Cmmittee in Endcrinlgy and Diabetes 1. Each EU and EFTA Member State will nminate a representative t sit n the ETAC. The nminee shuld be representative f Paediatric Endcrine and Diabetes practice within that cuntry and shuld ideally cme frm a Natinal Sciety f Paediatric Endcrinlgy and Diabetes. The representative must be apprved by the Natinal Paediatric Bdy fr that cuntry. Nn-EU/EFTA states may attend as bservers. 2. The ETAC will elect a Chair, Vice Chair and Secretary frm these representatives. 3. A representative f the ESPE Cuncil. 4. A representative f the Junir Dctrs training in Paediatric Endcrinlgy. 5. A representative frm the Internatinal Sciety fr Paediatric and Adlescent Diabetes. 6. An educatinalist. Cnstitutin 1. The Sub-Cmmittee will be knwn as the "Educatin and Training Advisry Cmmittee Endcrinlgy and Diabetes," hereafter referred t as the ETAC. 2. The Chair and Vice Chair, the Secretary and the Junir Dctrs' representative will serve fr a perid f 4 years in the first instance and may seek reelectin fr a further 4 year sessin. It is accepted that the Junir Dctrs psitin may change with circumstances. These terms will nt run cncurrently. 3. The ETAC will reprt directly t ESPE Cuncil and the Chair r Deputy Chair will represent the ESPE at the Meetings f the Eurpean Bard f Paediatrics. 4. The ETAC will meet at least nce per year. 5. Each representative frm a EU/EFTA state will carry ne vte. Observers are nt allwed t vte. Decisins will be by a majrity vte. Rle f the Educatin and Training Advisry Cmmittee in Endcrinlgy and Diabetes 1. Ensure that all trainees entering the Paediatric Endcrine and Diabetes prgramme have access t Eurpean and Natinal based. Career advice at utset f Training and meet the Eurpean and Natinal criteria fr entry. 2. Supervise and mnitr training standards in the EU and EFTA Member States in Paediatric Endcrinlgy and Diabetes in cnjunctin with the Natinal Bdies and the Eurpean Bard f Paediatrics. Wrk clsely with nn-eu States t ensure unifrmity f Training thrughut Eurpe. 3. Specify the training prgramme in Paediatric Endcrinlgy and Diabetes. 4. Liase with the Eurpean Bard f Paediatrics and the Natinal Bdies s that training prgramme and assessments meet the agreed

4 Return t Cntents Standards and prvide fr the Natinal Bdies an independent reference fr internal disagreements ver Training and Training Centre accreditatin. 5. Determine with Natinal Bdies that each Tertiary Care trainee has fulfilled requirements f the training prgramme and ultimately advise the Eurpean Bard f Paediatrics t award Eurpean Certificatin in Paediatric Endcrinlgy and Diabetes. 6. Advise the Eurpean Bard and the Natinal Bdies n the suitability f ther Dctrs t be recgnised as Eurpean and/r Natinal Specialists in Paediatric Endcrinlgy and Diabetes. 7. Prvide in cnjunctin with ther bdies apprpriate CME fr General Paediatricians and Paediatric Endcrinlgists/Diabetlgists 8. Determine and mnitr in cnjunctin with the Eurpean Bard f Paediatrics and Natinal Bdies the criteria fr recgnitin f Training Centres and Trainers. T prvide independent pinin and advice t Natinal Bdies in situatins where accreditatin issues are unclear r require arbitratin. Intrductin This dcument sets ut the minimum requirements fr training in Tertiary Care Paediatric Endcrinlgy and Diabetes. The dcument cnsiders general and specific aspects f training in endcrinlgy and delineates the syllabus. General cnsideratin is given t the structure f Eurpean Training and t the rganisatin f training in Eurpe. Training must lead smewhere and the current manpwer situatin in each Member State will need t be cnsidered with the apprpriate Natinal Paediatric Bdy. Finally, training is nt simply cnfined t Junir Dctrs but frms an integral part f Cntinuing Medical Educatin. This t is cnsidered in part. Tertiary Care Paediatric Endcrinlgy and Diabetes was recgnised as such by the Cnfederatin f Eurpean Specialists in Paediatrics (CESP) at the Annual Meeting in Graz 1996 and is a subsectin f CESP. The situatin with respect t Natinal Bdies varies within the Eurpean Unin (EU). Fr example, in the United Kingdm pure subspecialty status is, as yet, nt recgnised in the award f a Certificate f Cmpletin f Specialist Training (CCST). The Ryal Cllege f Paediatrics and Child Health (RCPCH) is prepared t cnsider issuing certificatin in the fllwing:- a. General Paediatrics with a Special Interest. b. Paediatric Endcrinlgy and Diabetes as a Subspecialist A similar situatin may pertain in ther EU Member States. It is expected that there will cntinue t be a need fr bth types f individuals in the majrity f Member States s the training prgramme will need t be mdified t suit each Member State. This dcument cncentrates n the Training required fr practice as a Tertiary Specialist. Where Member States wish t create General Paediatricians with a Special Interest then their prgramme shuld be agreed with ESPE. In sme EU Member States paediatricians are experts in diabetlgy but nt in ther fields f endcrinlgy. This fact is recgnized as a specialist in paediatric

5 diabetlgy must nt necessarily be a tertiary specialist in paediatric endcrinlgy. Hwever, a tertiary specialist in paediatric endcrinlgy must have a gd knwledge in diabetlgy, as defined in this dcument. The training prgramme intends t: Harmnise training prgrammes in Endcrinlgy and Diabetes between different Eurpean cuntries. Establish clearly defined standards f knwledge and skill required t practice Endcrinlgy and Diabetes at secndary and tertiary care level. Fster the develpment f a Eurpean netwrk f cmpetent tertiary care centres fr Paediatric Endcrinlgy and Diabetes. Imprve the level f care fr children with cmplicated r chrnic endcrine disrders. Return t Cntents Paediatric Training in Eurpe The CESP is the specialist sectin f paediatrics f the Eurpean Unin f Medical Specialities (UEMS). Represented are the member cuntries f the Eurpean Unin and the Eurpean Free Trade Assciatin. In additin CESP has admitted subspecialties t their meetings and after successful applicatin in 1996 Endcrinlgy is represented by the Eurpean Sciety fr Paediatric Endcrinlgy. The task f harmnising training prgrammes and training assessments thrugh Eurpe lies within the remit f the Eurpean Bard f Paediatrics (EBP) which has been specifically charged by CESP with this task. T achieve this EBP will recmmend the standards fr specialist training in paediatrics including training quality, syllabus and minimal standards fr training centres. T this end recgnitin has been given t the diverse training needs f different types f Paediatrician and carefully cnstructed training prgrammes have been prpsed. The EBP has designed the fllwing training system: A. Cmmn Trunk - a three year training in basic Paediatrics which serves as the cmmn basis and prerequisite fr all ther training prgrammes. B. Primary Care Paediatrics - a 2-3 year prgramme t prduce a General Paediatrician C. Secndary Care Paediatrics - a 2-3 year prgramme prducing a Paediatrician with r withut a special interest practising in a hspital setting. D. Tertiary Care Paediatrics - a 3 year prgramme t generate an individual with a cmmitment f greater than 0.6 Whle Time Equivalents emplyed in a hspital setting and academically active. E. Scial and Cmmunity Paediatrics - prbably part f (B) but t be defined mre adequately in due curse. The present training prgramme is largely devted t prviding fr (C) and (D)but it is recgnised that cntributins will need t be made t the Cmmn Trunk and prbably (B). The status f (E) within Eurpean Paediatrics remains t be determined.

6 The training syllabus fr the Cmmn Trunk has been devised by the Eurpean Bard f Paediatrics and will be published separately. Cnsiderable flexibility needs t be maintained t allw fr individual chice and t allw fr changes in directin by the trainee. All time requirements suggested shuld be viewed as the minimum. Return t Cntents General Aspects f Training in Paediatric Endcrinlgy General Principles A medical dctr wh has successfully cmpleted his/her training f at least 3 years in the Cmmn Trunk f Paediatrics will be eligible fr access t further specialist training in Paediatric Endcrinlgy. If a dctr is dedicated t Paediatric Endcrinlgy, training may be initiated at an earlier stage. Until a clearer picture emerges f the prvisin f Secndary and Tertiary services and the interrelatinship between the tw there will be n limitatin n the numbers f candidates fr specialist training ther than that which arises as a result f the designatin f Training Centres and Trainers. Each EU Member State at present will need t mnitr its wn Manpwer in Endcrinlgy and Diabetes. Hwever, in rder t ensure that there is a rising standard in Secndary Care Paediatrics particularly fr emergency treatment f endcrine prblems Training fr this shuld be undertaken in cnjunctin with the Tertiary Care Prgramme. Where Member States wish t encurage the Training f General Paediatricians with a Special Interest then the Training Prgramme shuld be discussed with ESPE and the Natinal Bdy. A tw level training prgramme is prpsed which will allw fr adequate training fr Secndary and Tertiary Care Paediatricians. 1. Fundatin Curse in Paediatric Endcrinlgy and Diabetes The aim f the Fundatin curse in Paediatric Endcrinlgy and Diabetes training wuld be t prvide training t allw cmpetent practice at Secndary Care Level and fr thse Member States wh wish t train General Paediatricians with a Special Interest. It is likely that such an individual wuld be expected t prvide care fr:- the district diabetic ppulatin children with primary hypthyridism individuals with delayed puberty grwth hrmne deficient children shrt and tall stature children children with besity and as such it wuld be expected that such an individual wuld have cvered at least 4 ut f these 6 areas. Each f these areas can be cnsidered a

7 mdule (See sectin n Training Syllabus Delivery). Mre cmplex endcrine prblems culd be cared fr lcally but nly in the cntext f a jint Cnsultative Clinic held with a Tertiary Care Paediatric Endcrinlgist. This cncept f a jint wrking partnership is central t this prpsal. This culd take the frm f utreach clinics held jintly and/r the Paediatrician with an Interest wrking with the Tertiary Specialist in Paediatric Endcrinlgy at their Endcrine Centre. Entry wuld take place after the Cmmn Trunk and after 1 year f the Secndary Paediatric Training. One t tw years wuld then be spent in Paediatric Endcrinlgy and Diabetes. It shuld be pssible als with this type f training t gain accreditatin in Diabetes nly. The training t secndary level paediatric endcrinlgist shuld preferably include clinical research activity. 2. Advanced Curse in Paediatric Endcrinlgy and Diabetes The aim f the Advanced curse in Paediatric Endcrinlgy and Diabetes training wuld be t prvide training t allw cmpetent practice t be undertaken as a Tertiary Care Specialist in Paediatric Endcrinlgy and Diabetes whse practice wuld be expected t deal with cmplex endcrinlgy:- disrders f the adrenal gland ambiguus genitalia disrders f the anterir and psterir pituitary gland excluding islated grwth hrmne deficiency hyperthyridism cmplicatins f diabetes diabetes with pr metablic cntrl early puberty hypglycaemia disrders f calcium metablism liaisn with adult and paediatric clleagues re cmplex cases eg. pst nclgy. and as such it wuld be expected that in additin t the Fundatin Curse the Specialist wuld have cvered at least 7 f these 9 areas. Each f these areas can be cnsidered as a mdule (See sectin n Training Syllabus Delivery). Entry wuld take place after the Cmmn Trunk and after 1 year f Secndary Paediatric Training. They wuld then cmplete a 3 year dedicated prgramme in Paediatric Endcrinlgy. The prgramme need nt be as segregated as this. Rather an integrated apprach culd be taken which will include an excellent expsure t clinical Paediatric Endcrinlgy, time t develp a research interest (cntinue ne) with perids f time dedicated twards labratry experience/adult liaisn. Time spent in Research shuld be viewed as essential fr a Specialist in Endcrinlgy and Diabetes with a minimum perid f 1 year t be spent in Research and ideally 3 years. A higher degree (MD r PhD) is desirable. If training/research in Pediatric Endcrinlgy is perfrmed n a part-time basis, the time t cmplete training must be extended t cmpensate fr this. Emphasize shuld be n achieved skills.

8 3. Flexibility and Cntinuing Medical Educatin There is a need t maintain flexibility. This will allw thse wh are undecided t pursue Secndary Training and then change acrss t Tertiary Training if they wish and als allw thse wh embarked n Tertiary Training T g t be a Secndary Care Paediatrician if specialist practice is nt fr them. Further it is clear that individuals within each f the tw grups may wish t develp persnal skills in certain areas. It is clear that different levels f clinical respnsibility are expected frm the tw grups althugh it is clear that this is based n the experience gained as trainees. It is envisaged that by emplying a mdular apprach t the Endcrinlgy and Diabetes training that a persns accreditatin might be mdified with time if they underwent subsequent mdular training in certain cmpnents f the advanced curse eg. disrders f the adrenal gland. 4. Research Training Apart frm a suggested year f clinical research there is n active prgramme at present fr prsecutin f a research prgramme within the Eurpean Prgramme. It is unclear when this shuld be cnducted but suggestins nw centre n attainment f a MD/PhD by prsecuting research with the aim f presenting a thesis. These arrangements will need t be negtiated with the Natinal Bdy. Where Academic University appintments are available fr a 4 year perid this time shuld be devted largely t research with a clinical research rati f 1:3. Return t Cntents Cntents f Training Paediatric Endcrinlgy is part f the Cmmn Trunk and this has been develped by the EBP and will be published as a separate dcument frm CESP in due curse. The principles f training required fr Secndary and Tertiary Care Paediatric Endcrinlgy and Diabetes Higher Specialist Training can be brken dwn int cre training and multi-disciplinary training and a mre detailed syllabus with a break dwn f subjects int the Fundatin and Advanced Curse cmpnents is prvided in Appendix 1. The sectin n Training Syllabus Delivery details the mdular structure. 1. Cre Training This shuld invlve the fllwing: i. Backgrund A thrugh mdern grunding in the nrmal physilgy f the endcrine system including the physilgy and bichemistry f hrmnes and their actins. Embrylgy f the endcrine system including that f the reprductive rgans cupled with extensive knwledge f the pathphysilgy f disrders f the genital tract are required. Physilgy and pathphysilgy f grwth alng with knwledge f the principles and practice f anthrpmetric assessment.

9 ii. Endcrinlgy Extensive first hand practical experience in a recgnised training centre f the management f diseases primarily invlving the endcrine system. These shuld include disrders f the fllwing:- the thyrid gland the neurendcrine system (hypthalamus and pituitary) the adrenal glands endcrine functin f the gnads the endcrine system in grwth and develpment hrmnal cntrl f bld pressure. fluid and electrlyte disrders In particular a detailed knwledge f clinical labratry and genetic management f adrenal disrders particularly adrenal hyperplasia and disrders f sexual differentiatin are essential. iii. iv. Diabetes Extensive experience in all aspects f diabetes mellitus and its acute cmplicatins, and gd knwledge f lng term cmplicatins f diabetes. This includes: Management f acute prblems particularly diabetic ketacidsis and cerebral edema Advising diabetes mnitring and evaluatin f cntrl. Early detectin and preventin f eye, kidney, neurlgical and vascular cmplicatins. Secndary diabetes (assciated with e.g. cystic fibrsis, sterid treatment and ther medicatins). Knwledge f the assciatin between type 1 diabetes and ther diseases (e.g. plyendcrine syndrmes, assciatin with thyrid disease, adrenal disease, celiac disease). Knwledge f the treatment f ther types f insulin lack ccurring in childhd (e.g. maturity nset diabetes f the yung (MODY),transient nenatal diabetes). Type II diabetes Psychlgical and cmmunity aspects f chrnic illness in childhd. Skills in diabetes educatin fr children, adlescents and parents (preferentially in teamwrk). Metablic disease First hand practical experience in metablic and nutritinal disrders including the fllwing:- hypglycaemic disrders and acute metablic diseases endcrine besity and its cmplicatins v. Labratry endcrinlgy An understanding f the principles and practice f hrmne assay methds and the use f diagnstic tests is essential. Training shuld include practical experience in an endcrine labratry and the endcrinlgist shuld have access t an up-t-date hrmne assay service which shuld participate in natinal quality cntrl schemes.

10 An understanding f the principles and practice f cellular and/r mlecular bilgy techniques particularly with respect t endcrine disrders. Practical experience is desirable but nt essential. The labratry wrk experience may be btained as part f a research pst. 2. Multidisciplinary Training i. Clinical This is particularly imprtant in the fllwing areas:- liaisn with adult endcrinlgists is essential and culd be prvided within the setting f jint adlescent clinics. liaisn with ther paediatric subspecialties particularly thse in which endcrine cmplicatins f the disease prcess are imprtant eg. pst nclgy therapy and renal disease. surgical endcrinlgy: invlvement in pre- and pst-perative management f pituitary disease, diabetes and thyrid disease. access t and experience with imaging facilities fr endcrine disease such as radiistpes, ultrasngraphy and magnetic resnance imaging. invlvement with a multidisciplinary team in the management f disrders f sexual differentiatin eg. gynaeclgists, andrlgist, urlgists, mlecular bilgists and bichemists. Bistatistics Backgrund knwledge f statistical and epidemilgical principles shuld be included in training prgrammes as part f the research training t allw fr critical appraisal f publicatins, reviews and audit prgrammes. ii. Audit Expsure t and practical invlvement in clinical audit shuld be cnsidered as an integral part f all training prgrammes iii. Persnal Develpment Acquisitin f management and educatinal skills. Return t Cntents End Result f Training The training prgramme envisaged and detailed in Appendix 1 will prvide fr the needs f:

11 Secndary Care Paediatricians wh will deliver emergency care and fr the cnditins utlined under the Fundatin Curse if apprpriate t the Natinal Structure. Tertiary Care Paediatricians wh will deliver care fr the cnditins utlined under the Advanced Curse. The Tertiary Care Endcrinlgist, at the end f training, shuld: Prvide clinical care within the framewrk f a specialised Tertiary Care Unit in the inpatient/utpatient setting using varius specialised diagnstic and therapeutic mdalities. Liaise with clleagues in Secndary Care Paediatrics in the prvisin f high quality lcal care. Liaise with and cnsult t ther Tertiary Care Specialists. Develp an integrated pattern f care with clleagues in the Adult Speciality. Be trained in Clinical Research Practice and capable f cnducting/establishing a Research Prgramme. Lead n health administrative issues and research activities. Return t Cntents Requirements fr Training Institutins The recgnitin f training institutins will ultimately be part f the remit f a CESP Standing Advisry Cmmittee (SAC) fr Endcrinlgy and Diabetes. It is anticipated that ESPE will act as the agent fr the Eurpean Bard f Paediatrics and CESP in executing this task. A list f the names and characteristics f existing natinal training centres in endcrinlgy and diabetes will be created and held by SAC/ESPE/EBP which will rganise in a structural manner quality assurance f the recgnised centres at peridic intervals every 5 years using the guidelines suggested by the UEMS. A training centre can be a single institutin r a grup f related establishments. Full Training Centre - The centre must prvide adequate experience in all fields f endcrinlgy including emergency care. It is expected t prvide all Training mdules. A full cmpnent f the Fundatin and Advanced Curses must be prvided. The number f activities must be sufficient t prvide at least a minimum experience fr a trainee. A grup f related establishments can be cnsidered a centre and each cmpnent cnsidered as a unit cntributing ne r mre mdules t either the Fundatin r Advanced Curse. The centre must have easy access and clse relatinships with ther relevant specialities such as nuclear medicine, imaging facilities, surgery and endcrine labratry facilities. Demnstratin f invlvement f ther care teams particularly specialized diabetes nurses, pediatric nutritinists, scial wrkers, and psychlgists is essential fr recgnitin. and thers wh may cntribute t the quality f care f patients with endcrine. The centre must prvide evidence f nging clinical research and access t basic research. In cuntries that have apprved centres fr diabetes care then the Full Training Centre must be ne f these. The centre will be respnsible fr weekly clinical staff/seminar teaching and participatin in reginal/natinal meetings. Basic

12 textbks in endcrinlgy/diabetes shuld be immediately available and there shuld be easy access t a cmprehensive reference library either in paper r electrnic frmat. Training Unit - Training Units are institutins that prvide training in ne r mre aspects (Mdules) f the Fundatin and/r Advanced Curses. They must prvide adequate expsure in the defined area and a teacher wh is deemed cmpetent in these areas. Return t Cntents Requirements fr Teachers in Paediatric Endcrinlgy/Diabetes The training staff in a Centre shuld include at least tw teachers. The Crdinatr f Paediatric Endcrine/Diabetes Training must have been practising Paediatric Endcrinlgy and Diabetlgy fr at least 10 years and have specialist accreditatin. There shuld be additinal Paediatric Endcrine/Diabetes Tutrs wh shuld prvide training in all aspects f the speciality and hld a research traditin in Paediatric Endcrinlgy. When an aspect f training cannt be prvided in ne centre it wuld be necessary fr the trainee t be taught elsewhere by a teacher (Paediatric Endcrine/Diabetes Teacher) apprved fr that purpse. A Teacher is a persn wh hlds acknwledged expertise in ne r several aspects f Paediatric Endcrinlgy/Diabetes. This persn's cntributin may be restricted t these areas f expertise. Bth Tutrs andteachers must have practised Paediatric Endcrinlgy/Diabetes fr a minimum f 5 years. The teacher shuld wrk ut a training prgramme fr the trainee in accrdance with the trainee's wn qualities and the available facilities f the institutin. The plan will be submitted t the Crdinatr fr apprval. In the event f disagreement ESPE with the Eurpean Bard will be the final arbiter. Regular review will be required t allw fr flexibility and t allw fr early identificatin f prblems/deficiencies. Teachers are expected t prvide appraisal and assessment f prgress. Appraisal cnsists f srting ut what is needed and what is the evidence that this has been executed. Assessment cncentrates n what is needed. Trainee assessment shuld be prvided in terms f:- training and career ambitins training experience related t syllabus achievements related t current plan. In rder t prvide a clse persnal mnitring f the trainee during his/her training, the number f trainees shuld nt exceed the number f teachers in the centre. A tutr, preferably an external teacher, shuld be appinted t act as an impartial assessr/mentr fr the trainee. Teachers will meet the trainee at the beginning f the prgramme t define the educatinal cntract fr that trainee. Reviews f prgress shuld take place at 3 mnthly intervals t appraise the individual. An annual assessment shuld be undertaken t state cmpetencies achieved and t allw prgress within the teaching prgramme. Assessments shuld be detailed and cntain statements f theretical and practical experience accumulated by the trainee. It is expected that the trainee

13 will als prvide an accunt f the training received and prblems encuntered. Reprts will be submitted t the Crdinatr. Each trainee n a secndary level shuld be assigned a mentr in a tertiary paediatric endcrine clinic. Return t Cntents Requirements f Trainees In rder t gain the necessary depth f experience each trainee shuld be actively invlved in the management care f different endcrine patients during the whle perid f his/her speciality training. This shuld include the care f utpatient and inpatients and patients with endcrine emergencies where pssible. The trainee shuld keep a written recrd f patients seen by themselves, prcedures cnducted, diagnsis and therapeutic interventins instigated and fllwed-up. This will cnstitute in part the lgbk. The trainee will be required t keep his/her persnal lgbk r equivalent up-t-date accrding t Natinal guidelines and Eurpean Unin directives. The lgbk must be endrsed by his/her tutr r authrised deputy. The trainee shuld attend and prvide evidence f attendance at lcal, reginal and natinal Endcrine and Diabetes Meetings. Attendance at Internatinal Meetings is nt essential fr the Fundatin curse but is cnsidered essential fr the Advanced curse. A Fundatin curse member is recmmended t give at least 2 and an Advanced curse student at least 3 presentatins at these meetings. Participatin in ne Audit prject fr Fundatin curse and tw fr Advanced curse students. Advanced curse students shuld cnduct ne systematic style review f a tpic and in additin prepare a detailed evidence based appraisal f a diagnstic test r a therapeutic interventin. The Trainee is encuraged t prvide as evidence f training a series f Signs f Persnal Develpment. These shuld include:- Brad experience f endcrinlgy within a single centre and between centres including wrk in ther cuntries. Attainment f Higher Degrees (MD r PhD). Creatin f Trainee Prtfli which wuld include, lg-bk, abstracts f wrk presented, reviews, self-directed learning activities (SDLA) and evidence based appraisals. Creatin f clinical management wrkbk. SDLA includes reading activities, tutr discussins, self-teaching prjects, teaching and presentatin and participatin in cmputer/distance based learning schemes. papers published in Internatinal peer reviewed jurnals. At least ne as first authr. papers presented at Internatinal Endcrine Meetings. In the lnger term fr Eurpean Bard f Paediatrics Certificatin in Paediatric Endcrinlgy an examinatin may need t be cnsidered in additin t the abve. This wuld be a practical examinatin f the trainee's apprach t a series f clinical situatins. Return t Cntents

14 Accreditatin f Centres Fr each EU Member State, a list f centres, units, training directrs, tutrs and teachers shuld be cmpiled and updated n an annual basis. Each centre is defined by the available mdules r areas f teaching activity, tutrs and teachers available and the size f the clinical practice as defined by the needs f the trainee. Accreditatin will initially be given by the Natinal Paediatric Bdy and ultimately by ESPE. The prcess fr Natinal Representatin in ESPE will be evlved with time and the inspectin and apprval prcess will fllw the EU Guidelines currently in preparatin. At present ESPE will simply review Natinal Inspectins and act as arbiter in situatins f disagreement. Return t Cntents Delivery f the Training Prgramme The delivery f the Training Prgramme relies n the recgnitin f centres and teachers as described abve alng with the prcess required fr trainee assessment. In rder t facilitate these prcesses a mdular apprach t the Prgramme is utlined. The mdular apprach allws fr: Trainee assessment in either the Fundatin r Advanced Curses r bth. Assessment f Training Centres r Units in terms f what they can deliver. Develpment f CME in the true sense f the cncept with pst-accreditatin in add-n Mdules. This will allw flexibility between Secndary and Tertiary Care t develp. The Fundatin and Advanced Mdular apprach invlving Secndary Care is the preferred mde f Training in the EU Cuntries in Endcrinlgy and Diabetes because f the wish f Member States t prmte the develpment f higher quality services fr grwth disrders and diabetes at the Secndary level. 1. Fundatin r Obligatry Mdules Clinical Fundatin Studies in Endcrinlgy Mdule BK: Basic knwledge f Endcrine Science. This shuld include the general principles f mlecular bilgy, transprt, bichemical actins and cntrl f hrmne secretin and secndary messenger signalling systems, the neurendcrinlgy f the anterir and psterir pituitary hrmnes, sterid bisynthetic pathways and the basic immunlgy with an emphasis n autimmunity. A wrking knwledge f the embrylgy f the endcrine system and f the genital tract is expected. Mdule GA: Grwth Assessment The principles and practice f grwth assessment including height, weight and pubertal assessment. Uses f grwth charts and quality cntrl f grwth measurements. Mdule GB: Bne Age Assessment Assessment f bne age and determinatin f height predictin.

15 Determinatin f bne age and height predictin in 50 patients with nrmal and abnrmal grwth. Mdule PM: Patient Management Evidence f utpatient and inpatient assessment f the cnditins listed belw (numbers indicate the minimum number f cases). This includes recgnitin, institutin f diagnstic tests, interpretatin and utline management. Creatin f clinical management wrkbk. Mdule PMT: Hypthyridism Diagnstic prcedure and interpretatin f 15 cases with hypthyridism. Where practical (and mandatry in sme EU Member States) 20 ultrasund studies f the thyrid. Mdule PMG: Grwth Disrders Diagnstic prcedure and interpretatin f 50 cases with significant grwth disrders and therapeutic management and mnitring f 15 cases. Mdule PMH: Hypglycaemia Emergency management and diagnstic investigatin. Mdule CAM: Clinical Audit and Management Evidence f audit and management activity as utlined in Syllabus. Mdule TA: Therapeutic Agents Use f therapeutic agents fr Mdule PM with understanding f pharmackinetics/dynamics f agents used, side effects and ptential fr drug interactins. Mdule DM:Diabetes Mellitus Mdule DMG:General Issues in Diabetes Physilgy f insulin actin and metablic effects f insulin deficiency. Knwledge f the pharmaclgy f insulin. Mdule DAC:Acute issues in Diabetes Presentatin f type 1 diabetes mellitus in infancy, childhd and adlescence and management f diabetic ketacidsis, hyperglycaemia, hypglycaemia and cerebral edema. Management f diabetic patients during surgery. Mdule DLT:Lng term issues in Diabetes Cmplicatins f diabetes and diabetes assciated with ther diseases eg cystic fibrsis and mitchndrial disrders. Management f 40 patients with diabetes mellitus. Mdule DAD:Adult Diabetlgy Sessins with adult diabetlgists/nephrlgists/pthalmlgists. With particular reference t Type 2 Diabetes. Mdule LE: Labratry Endcrinlgy Principles f gd labratry practice and the limitatins f cmmnly used endcrine tests. Mdule MTR: Multi-disciplinary Training The rle f jint adlescent clinics in prviding endcrine/diabetes needs fr yung adults and transferring t adult endcrine/diabetes practice. Adlescent perspectives f chrnic illness. Develp teamwrk apprach t diabetic care,

16 dietician, nurse specialists, psychlgist and the cncept f diabetic in the family and cmmunity. Academic Fundatin in Endcrinlgy Mdule BS: Basic Statistics Cver apprpriate tpics in Syllabus sectin. Mdule ED: Educatin Self directed learning prjects, literature searching, presenting infrmatin and cnsultatin practice 2. Advanced r Desirable Mdules Advanced Clinical Studies in Endcrinlgy MduleCE: Cmplex Endcrinlgy MduleCET: Thyrid Mlecular and immunlgical mechanisms f thyrid disease. Management f 10cases with gitre r hyperthyridism. Mdule CEN: Neurendcrine Disrders affecting anterir and psterir pituitary functin ther than idipathic islated Grwth Hrmne prblems. Diagnstic prcedure and interpretatin f 10 cases with hypthalamicpituitary disrders which must include the management f pituitary dependent Cushing's and pst-perative management f cranipharyngima/pituitary surgery. Mdule CEA: Adrenal Mlecular and sterid bichemistry f adrenal disrders. Diagnstic prcedure, interpretatin and therapy f 10 cases with adrenal disrders. Mdule CEG: Ambiguus genitalia Mlecular and bichemical backgrund t disrders f sexual differentiatin. Multi-disciplinary apprach t the management f the prblem. Detailed clinical wrkbk presentatin f at least 4 different types f prblem. Mdule CEC: Calcium Disrders Mlecular and bichemical backgrund t disrders f calcium metablism. Diagnstic prcedure and interpretatin f 5 cases with disrders f bne r calcium/phsphrus metablism. Mdule CEM: Endcrine Metablic Disrders Diagnsis and management (medical and surgical) f hypglycaemia. Mdule CL: Cmplex Labratry Wrk Principles f radiimmunassay and newer technlgies. Sterid hrmne analysis by chrmatgraphy and mass spectrscpy. Assessment f assay perfrmance and quality cntrl. Principles f mlecular bilgy including analysis f DNA and RNA, rle f PCR and semi quantitative assessment. Mdule MT: Multi-disciplinary Training Mdule MTA: Adult Endcrinlgy Attendance at Adult Endcrinlgy clinics (frmal invlvement fr 6 mnths).implicatins f childhd endcrine disease fr Adult Endcrinlgy.

17 Mdule MTT: Adlescent Transfer The rle f jint adlescent clinics in prviding endcrine/diabetes needs fr yung adults transferring t adult endcrine/diabetes practice. Participatin in this prcess. Adlescent perspectives f chrnic illness Mdule MTE: Endcrine Cmplicatins f ther Paediatric Diseases Experience f jint clinics/liaisn in at least ne f the fllwing: nclgy and raditherapy renal disease respiratry disease Mdule MTS: Surgical Management f Endcrine Disease Experience f liaisn regarding management f patients with pituitary, thyrid, pancreas and adrenal disrders and the pst perative care f these individuals. Advanced Academic Studies in Endcrinlgy Mdule AS: Advanced Statistics See Syllabus Sectin G. Mdule RS: Research Activities Attendance at lcal, reginal and natinal Endcrine and Diabetes Meetings and at least 3 Internatinal Meetings. Participatin in tw Audit prjects, ne systematic style review f a tpic and preparatin f a detailed evidence based appraisal f a diagnstic test r a therapeutic interventin. Tw papers as first authr published in Internatinal peer reviewed jurnals. Preferably, a PhD r MD degree shuld be an integrated part f the tertiary training in paediatric endcrinlgy, diabetes and metablism Attendance at lcal, reginal and natinal Endcrine and Diabetes Meetings. Return t Cntents Natinal Training Prgrammes 1. EU Cuntries with Existing Prgrammes Natinal training prgrammes in Paediatric Endcrinlgy/Diabetes that already exist, r are in an advanced stage f develpment shuld be cnsidered as cmpatible when they: have a cntent that is cmparable (nt strictly identical) with the Eurpean prgramme. has a duratin that des nt differ by mre than ne year frm the Eurpean prgramme. Each Natinal syllabus shuld be clsely scrutinised by ESPE/ISPAD fr cmpatibility. If cmpatible the trainees within that prgramme wuld be cnsidered as acquiring the title f " Eurpean Paediatric Endcrinlgist. "

18 2. EU Cuntries withut Existing Prgrammes Natinal prfessinal medical bdies shuld be encuraged t adpt a Natinal training prgramme in Paediatric Endcrinlgy and t structure it in clse cmpatibility with the Eurpean mdel. Until implementatin f such a natinal training prgramme, individuals shuld have the pprtunity t train accrding t the Eurpean prgramme and t dcument their prgress in a similar fashin. Review f prgress wuld be made by the Eurpean Bard f Paediatrics in cnjunctin with ESPE. 3. Nn-EU Eurpean Cuntries with Existing Prgrammes If the natinal training prgramme is fund t be cmpatible with the Eurpean prgramme then the trainee can be awarded the title f "Eurpean Paediatric Endcrinlgist." 4. Nn-EU Eurpean Cuntries withut Existing Prgrammes On a vluntary basis, the same arrangements as listed under" EU Cuntries withut existing prgrammes" shuld apply. Return t Cntents APPENDIX 1 Eurpean Sciety fr Paediatric Endcrinlgy Syllabus fr Tertiary Training in Endcrinlgy and Diabetes The cmpnents f the tw curses are dented by (F) Fundatin and (A) Advanced. All expected t cver sectins A, C, E, F, H, I and J. As Endcrinlgy and Diabetes are predminantly Outpatient Specialities it isn't pssible t state precise times t be spent in each mdule. Cmpetence rather than time spent in a mdule/teaching area is desired. As a result Training Centres/Mdules are defined n patient numbers seen at the centre as well as the case-mix. The trainee shuld keep a written recrd f patients seen by themselves, prcedures cnducted, diagnsis and therapeutic interventins instigated and fllwed-up. A. Fundatin Studies in Endcrinlgy Basic knwledge general principles f mlecular bilgy. Specific reference t the mlecular regulatin f the GH gene and sterid hrmne actin at the mlecular level secndary messenger signalling systems used in the endcrine system neurendcrinlgy f the anterir and psterir pituitary hrmnes and their actin transprt, bichemical actins and cntrl f hrmne secretin sterid bisynthetic pathways embrylgy f the endcrine system embrylgy f the genital tract and mlecular basis fr sexual differentiatin principles f grwth assessment Basic immunlgy with an emphasis n autimmunity

19 Skills ability t cnduct an anthrpmetric assessment, assessment f skeletal maturatin and predictin f final height and staging f pubertal develpment. Resurces endcrine clinics liaisn with basic scientists sessins dedicated t basic science issues structured in-huse, ESPE Summer Schl, endcrine teaching curse Natinal and Internatinal pstgraduate curses including ESPE Summer and Winter annual meetings f Natinal and Internatinal Endcrine Scieties including ESPE Evaluatin clinical prgress curse attendance supervisin f anthrpmetric techniques membership f learned endcrine scieties eg. Natinal Endcrine Scieties, Endcrine Sciety (USA), Eurpean Sciety fr Paediatric Endcrinlgy. Literature Clinical and basic science reviews in Jurnal f Clinical Endcrinlgy and Metablism, Endcrinlgy, Endcrine Reviews, Clinical Endcrinlgy and Jurnal f Endcrinlgy Williams Textbk f Endcrinlgy.. Saunders. Brk CGD, Hindmarsh PC. Clinical Paediatric Endcrinlgy. Blackwell Scientific Publicatins, Oxfrd,. De Grt LJ. Endcrinlgy. Saunders, Philadelphia Fima Lifshitz ed. Pediatric Endcrinlgy,,, Dekker The Metablic and Mlecular Bases f Inherited Disease Vl II. Eds Scriver C R, Beaudet A L, Sly W S, Valle D.McGraw Hill New Yrk, Endcrinlgy and Metablism. Eds Philip, F, Baxter J D, Frhman L A. McGraw-Hill New Yrk 3rd editin. B. Principles and Practice f Endcrinlgy fr Fundatin and Advanced Curses Basic knwledge recgnise, initiate diagnstic tests and utline management and referral criteria (F) f:

20 hyp (F) and hyperthyridism gitre and ndules neurendcrine system eg. Cushing's disease (A) adrenal hyper and hyp states including cngenital adrenal hyperplasia(a) early and late sexual develpment (F) ambiguus genitalia (A) shrt stature, grwth delay, excessive grwth, and (F) hypglycaemia (F) fluid and electrlyte disrders (F) evaluate bichemical, radilgical and ther tests used in endcrine practice (F) pharmaclgy f (cmmnly used (F)) therapeutic agents (A) management f endcrine prblems in adlescence (A) Skills administer and interpret investigatins fr endcrine disrders particularly the fllwing: anterir and psterir pituitary functin tests endcrine functin tests (and in sme EU Cuntries ultrasund studies f the uterus and varies) in the diagnsis f disrders f sexual differentiatin and pubertal develpment thyrid functin evaluatin (and in sme EU Cuntries ultrasund studies f the thyrid). Interpretatin f the results f nenatal screening fr cngenital hypthyridism. endcrine functin and radilgical assessment f adrenal dysfunctin including nenatal evaluatin f CYP21 deficiency frm the bichemical and mlecular standpint and the rle f antenatal diagnsis and treatment. cmpetence in understanding pharmackinetics/dynamics f therapeutic agents used develpment f effective cmmunicatin strategies Resurces distance based learning lcal endcrinlgy prtcls and clinical service guidelines curses n cmmunicatin techniques Evaluatin attendance at clinics. Persnal invlvement in management f cnditins. individual case discussin real data interpretatin Literature Brk CGD, Hindmarsh PC. Clinical Paediatric Endcrinlgy. (4th Ed.). Blackwell Scientific Publicatins, Oxfrd.

21 Lifschitz F. Paediatric Endcrinlgy.. Marcel Dekker, New Yrk Williams Textbk f Endcrinlgy. C. Diabetes Basic knwledge Carbhydrate, fat and amin acid metablism and its enzymatic and endcrine regulatin. Physilgical effects f insulin and insulin deficiency Physilgy f insulin actin. genetics, immunlgy, epidemilgy and aetilgy f type 1 diabetes presentatin f type 1 diabetes in infancy, childhd and adlescence management f diabetic ketacidsis, hyperglycaemia, hypglycaemia cerebral edema management pharmaclgy f insulin cmplicatins f diabetes diabetes assciated with ther diseases eg cystic fibrsis and mitchndrial disrders predictrs f type 1 diabetes and interventin studies management f type 1 diabetes in adlescence besity and type 2 diabetes. Cncept f insulin resistance. management f type 2 diabetes MODY lipid disrders, celiac disease, hypthyridism assciated with diabetes Skills acute management f type 1 diabetes, rle f ITU injectin and mnitring skills insulin pumps develp teamwrk apprach t diabetic care, dietician, nurse specialists, psychlgist develp cncept f diabetic in the family and cmmunity administer and/r interpret tests t detect diabetic cmplicatins labratry experience f glycated prtein analysis Resurces register f diabetic patients quality register dedicated paediatric diabetic clinic team apprach t diabetic care. Act as bserver and team member n cnsultatins/fllw-up labratry liaisn sessins with adult diabetlgists/nephrlgists/phthalmlgists Evaluatin

22 clinic attendance mnitring and fllw-up f diabetic children individual case discussin and presentatins tracking f changes in markers f cntrl with respect t interventin research pprtunities Literature Pickup JC, Williams G. Textbk f diabetes. Blackwell Scientific Publicatin, Oxfrd, Kelnar CJ. Textbk f childhd and adlescent diabetes. Chapman Hall, Lndn D. Metablic Disease (A) Basic knwledge metablic bne disease and calcium disrders. plyuria/plydipsia. Investigatin f differential diagnsis. diagnsis and management f hypglycaemia (F) Skills ability t administer and interpret investigatins Resurces single r multiple endcrine centres may be required t cver this area in-depth Evaluatin attendance at clinics and persnal invlvement individual case discussin real data interpretatin Literature Williams Textbk f Endcrinlgy. (8th Ed). Brk CGD Clinical Paediatric Endcrinlgy. (3rd Ed). Blackwell Scientific Publicatins, Oxfrd. E. Labratry Endcrinlgy Basic knwledge principles f gd labratry practice (F) principles f radiimmunassay and newer technlgies eg. ELISA, chemluminescence difference between immun and biassays sterid hrmne analysis by chrmatgraphy and mass spectrscpy assessment f assay perfrmance and quality cntrl

23 principles f mlecular bilgy analysis f DNA and RNA rle f PCR semi quantitative assessment imprtance f sample cllectin limitatins f cmmnly used endcrine tests (F) Skills perfrm an immunassay Resurces time spent in endcrine labratry time spent attached t mlecular bilgy grup Mlecular bilgy curses Evaluatin cmpletin f labratry wrk t satisfactin f labratry manager regular review f labratry methdlgy as applied t clinical practice Literature Edwards, R. Immunassay. An intrductin. William Heineman Medical, Lndn, Thakker R (ed). Genetic and mlecular bilgical aspects f endcrine disease. Balliere, Strike, PW. Medical Labratry Statistics. Jhn Wright & Sns Ltd,Bristl, F. Multidisciplinary Training (A) Basic knwledge the rle f jint adlescent clinics in prviding endcrine/diabetes needs fr yung adults transferring t adult endcrine/diabetes practice adlescent perspectives f chrnic illness implicatins f childhd endcrine disease fr Adult Endcrinlgy endcrine cmplicatins f ther paediatric diseases nclgy and raditherapy renal disease respiratry disease the rle f surgery in managing endcrine disease applicatin f imaging techniques t endcrine evaluatin psychlgical implicatins f endcrine disease. Psychscial impact n endcrine disease. Skills

24 managing multidisciplinary teams Evaluatin attendance at Adult Endcrinlgy clinics (frmal invlvement fr 6mnths) attendance at jint paediatric subspecialty clinics fr the lng term fllw-up f cmplex endcrine prblems visit t hspital imaging services. Liaisn with imaging practitiners. Literature Brk CGD. Clinical Paediatric Endcrinlgy. Blackwell Scientific Publicatins, Oxfrd. Hfmann A. Adlescent Medicine. Addisn Wesley, Califrnia G. Bistatistics Basic knwledge applicatin f parametric and nnparametric statistics (A) statistical mdelling (A) methd cmparisn studies (A) principles f screening and surveillance prgrammes (F and A) study design (A) principles f health ecnmics evidence based endcrinlgy (F and A) critical appraisal f literature (F and A) principles f systematic reviews (A) place f infrmatin technlgy in clinical and research practice (F and A) Resurces university statistics clinic sessins with Health Services Research persnnel lcal IT netwrk Evaluatin critical appraisal f literature wrked examples trial design cnstructin f scientific paper/presentatin Literature

25 Statistical/health service reviews in New England Jurnal f Medicine, Lancet, British Medical Jurnal, Evidence Based Medicine Altman DG. Practical statistics fr medical research. Chapman and Hall, Lndn, Bailar JC, Mstellar F. Medical uses f statistics. New England Jurnal f Medicine Bks, Bstn H. Audit Basic knwledge the audit cycle identificatin and cnduct f audit studies prmting change Resurces disease registers hspital audit departments Evaluatin example(s) f audit prcess in actin Literature reviews and reprts in general medical jurnals. I. Management Basic knwledge time management chairing meetings and team participatin appraisal and assessment health ecnmics and service prvisin Resurces management curses run by the Kings Fund r ther agencies liaisn with clinical directr Evaluatin reprt n curses attended review f departmental wrking practices

26 Literature regular review articles in British Medical Jurnal/Lancet/New England Jurnal f Medicine J. Educatin Basic Knwledge defining aims f teaching curse/prgramme/lecture targeting different audiences preparatin f teaching material Resurces distance based learning using Web site educatin in pedaggics, curses students Evaluatin presentatin f lectures t different audiences bedside teaching prgrammes educatinal material develped