THE FELLOWSHIP TRAINING PROGRAM

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					                             THE FELLOWSHIP TRAINING PROGRAM


                   SECTION OF PEDIATRIC ENDOCRINOLOGY
                        DEPARTMENT OF PEDIATRICS

I. RATIONALE OF THE FELLOWSHIP PROGRAM

              Pediatric Endocrinology as a subspecialty has been in existence for the past 30 years.

  However, it was only in the past 10 years that graduates of a pediatric residency program have

  expressed interest in this field. The seeming rarity of endocrine problems of childhood is probably

  not true but more often, they are most likely unrecognized .

             At present, the only existing fellowship program in Pediatric Endocrinology is at the

  Philippine General Hospital which admits one fellow per year. Since priority is given to the

  residency graduates from the same institution, acceptance into the program is quite competitive.

  The number of endocrine cases seen at the PCMC-OPD Endocrine Clinic at the moment has not

  increased tremendously for the following reasons: 1) general pediatricians are not fully aware that

  there is an endocrine clinic ; 2) a general perception that when a patient needs work-up, the expense

  in a semi-private hospital would be prohibitive; 3) lack of an identified “permanent” doctor to

  coordinate their needs.

             Most of the endocrine cases are diagnosed and worked-up on an out-patient basis and

  only the true endocrine emergencies get admitted. There are however a large number of in- patients

  from other disciplines who require endocrine evaluation . The OPD census ranges from 8-10

  patients a week. The section believes that when the fellowship program gets in place, the patient

  data base will expand .
II. OBJECTIVES


   GENERAL: To train interested pediatricians become competent in the practice of
             Endocrinology as a subspecialty.

     SPECIFIC:

              1.    To provide basic knowledge in pediatric endocrine disorders , from clinical
              manifestations, pathophysiology, diagnosis and management.
             2.     To provide intensive training in the mastery of skills needed in the evaluation of
             a patient with endocrine-metabolic problem.
             3.     To provide training in the performance of special endocrine procedures.
             4.     To provide research opportunities in the subspecialty and related fields.
             5.     To provide an opportunity for establishing subspecialty practice in areas where
             it is needed.

III . TRAINING PROGRAM

            The program entails two years of clinical and research fellowship. The trainee will be
     exposed to other related disciplines through referral systems and multidisciplinary approach to
     patient care. There shall be one fellow per year level so that there will be two fellows per year
     after the initial implementation of the program. Training starts in January or July of each year
     depending on the availability of a slot.



     III-A. ROTATION AND ACTIVITIES

     First Year:

            The first 6 months is primarily clinical exposure in the wards and OPD Clinics. For in-
     Patients, both in the Wards and ICU, the fellow is expected to get a complete history and
     perform a thorough physical and neurologic examination. He/she makes a diagnostic and
     therapeutic plan and confers with the consultant-on-call for final implementation. She will
     perform pertinent diagnostic tests and procedures. Aside from daily rounds, she makes daily
      progress notes and as needed during the day. She will act as a junior consultant to the resident
      rotators and service residents in- charge of the patients.


              On the 7th to 8th month, arrangement for observation at the Nuclear lab of Rizal
      Medical Center will be made in such a way that the schedule will not disrupt her clinical rounds
      and will still           attend to the Tuesday             afternoon and Friday afternoon
      clinics at PCMC . This rotation allows the fellow to familiarize him/her with common endocrine
      diagnostic tests involving radioactivity such as RAIU, Thyroid Scan.

             On the 9th month, the fellow rotates in the Adolescent Service to provide her with the
      technical skills in dealing with adolescent patients with endocrine problems which are usually
      chronic.

            On the 10th month, ICU rotation will expose the fellow to management of true endocrine
      emergencies in an ideal setting.
            On the 11th month, fellow rotates at the Pediatric Gynecology service.
            On the 12th month, regular Ward and OPD clinic rotation.


      Second Year Rotation:

              The second year rotation is a consolidation of clinical and research work. Genetic service
      rotation will be incorporated . The Philippine Nuclear Research Institute offers an annual
      course on radioactive handling and therapy for one month which the fellow will attend.

      Other Activities
             Representation with a medical school for the fellow to attend basic lectures on
      physiology and biochemistry related to endocrine-metabolic issues shall be made. This will be
      done during the first year of fellowship if possible depending on the period of commencement of
      fellowship.
             Research protocol should be ready by the ninth month of first year . Completed research
      paper should be ready 1-2 months before completion of fellowship.


        ACTIVITIES OF THE SECTION:
             Monday          Tuesday                Wednesday       Thursday        Friday
8-9:30 a.m.  Hosp Conference                                        Hospital Confe-
                                                                    rence
10-12 a.m.
2-4 p.m.        Case Discussion General             Chart Review    Journal Club      Endocrine/
                Of OPD cases    Endocrine           Of Patients                       Diabetes Clinic
                                Clinic              Scheduled for
                                                    Friday
      TRAINORS:
           Dr. Lorna R. Abad
           Dr. Leticia A. Buenaluz
           Dr. Melinda M. Atienza
           Dr. Caridad Santos (Training Officer)
           Dr. Eve Fernandez


IV.      ADMISSION REQUIREMENTS

      1) The trainee must be a Filipino citizen licensed to practice in the Philippines.

      2) The required documents for submission include:
             • Transcript of Records
             • Diploma in Medicine
             • Certificate of Residency Training
             • Medical Board Rating
      3) The trainee must have passed at least the written phase of the PPS Specialty Board Exam at
         the start of the fellowship program. By the end of the program, the oral phase of the PPS
         diplomate exam should have been completed to make him/her eligible to take the Philippine
         Society of Pediatric Metabolism and Endocrinology subspecialty board.

      4) The trainee must take the written screening test and satisfactorily meet the interview
         requirement.

      5) The trainee must sign a contract for completion of the training program.

      6) The trainee must be of good moral character and submit letters of recommendation from:

             Chair / Training Officer of Residency Program
             Any active consultant of the residency program where she graduated.


V.       DUTIES OF THE TRAINEE

      A. CLINICAL RESPONSIBILITIES

         1. Coordinate all activities of the section.
         2. Attend major conferences of the Department.
         3. Make daily rounds of all pediatric endocrine patients and supervise residents in the
             management of these patients.
         4. Attend OPD Endocrine Clinic every Tuesday            and Friday afternoon and keep an
            organized record of all patients.
         5. Maintain record and log books of all patient referrals.
         6. Present and discuss cases during rounds.
         7. Prepare clinical case(s) for presentation to the scientific meetings of the Philippine
            Society of Pediatric Endocrinology and Metabolism.
         8. Present journal reports with critical appraisal and file CATS (Critically appraised topics)
            for future references.
         9. Perform laboratory procedures related to patient’s problem. Keep a logbook on all
            procedures done.


      B. RESEARCH REQUIREMENTS

         1. Participates actively and undertake research activities of the section. The fellow should
            be able to present a research protocol at the end of 6th month.

         2. Complete at least one prospective paper of which he/she is the principal investigator.
            Collaborative researches may be done with the consultants and residents in addition to
            the personal prospective paper.

         3. Present completed paper in a research forum before completion of the program.

VI.      EVALUATION

      1. Quarterly examination based on the topics discussed or presented. Feedback on the
      examination questions will be done no later than one week after the examination with the
      consultants.
      2. Case presentation : An interesting case will be discussed on a weekly basis
      3. Service Evaluation form for Ward Rounds
      4. Research Paper ( This is a requirement for graduation)
      5. Logbook of cases and procedures done
      6. PAEC examination ( A written evaluation from PAEC will be requested).
VII.   COMPETENCIES EXPECTED AT THE END OF TRAINING
       Clinical competence in pediatric endocrinology is expected of the trainee at the end of 2
       years. He/she should be aable to:

       1. Confidently make a diagnosis and differential diagnosis of an endocrine problem based
          on history and physical examination.
       2. Request cost-effective diagnostic procedures.
       3. Perform stimulation tests as necessary.
       4. Manage confidently endocrine problems.
       5. Counsel patients and families regarding complications, prognosis, and outcome of their
          endocrine conditions.
       6. Critically appraise medical journal articles.
       7. Prepare research protocols.